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Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors
Affiliations- Department of Neurosurgery, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
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Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are rare, acquired pathology and they inevitably lead to severe disability if untreated. The aim of this study is to present the outcome and complications, and to find factors that may affect the outcome after surgical treatment.
MethodsSeventeen consecutive patients (men – 14, women – 3, age: 41–79) were retrospectively analyzed. The patients presented with paraparesis (88%), bladder symptoms (71%) and/or sensory disturbances (65%). The fistula was found in the upper thoracic spine in 2 cases, in the lower thoracic (T7–Th12) in 11 cases, and in the lumbar spine in 4 cases. Microsurgical shunt interruption was performed in all, followed by epidural arteries coagulation in 12 cases.
ResultsIn the long term, improvement or achievement of a good stable condition was observed in 13 patients (76%), and no patient deteriorated. All 5 paraplegic patients improved by at least 1 grade in MCS. Satisfactory results (modified McCormick Scale grades I–II) were found in 10 patients (59%), and 15(88%) were independent. Postoperative complications occurred in 4 patients (24%), two of them (12%) required revision surgery for epidural hematoma. The success rate was 94%; one patient required revision surgery for recurrent SDAVF. Better neurological condition on admission (p=0.0098) and age >60 years (p=0.0498) were the factors associated with satisfactory outcome.
ConclusionsMicrosurgical closing of a SDAVF brings good and stable results over time. Aggressive treatment should be attempted even in cases of total loss of spinal cord function. Neurological condition before surgery and age may influence the outcome.
Abstract
Spinal dural arteriovenous fistulas (SDAVFs) are rare, acquired pathology and they inevitably lead to severe disability if untreated. The aim of this study is to present the outcome and complications, and to find factors that may affect the outcome after surgical treatment.
MethodsSeventeen consecutive patients (men – 14, women – 3, age: 41–79) were retrospectively analyzed. The patients presented with paraparesis (88%), bladder symptoms (71%) and/or sensory disturbances (65%). The fistula was found in the upper thoracic spine in 2 cases, in the lower thoracic (T7–Th12) in 11 cases, and in the lumbar spine in 4 cases. Microsurgical shunt interruption was performed in all, followed by epidural arteries coagulation in 12 cases.
ResultsIn the long term, improvement or achievement of a good stable condition was observed in 13 patients (76%), and no patient deteriorated. All 5 paraplegic patients improved by at least 1 grade in MCS. Satisfactory results (modified McCormick Scale grades I–II) were found in 10 patients (59%), and 15(88%) were independent. Postoperative complications occurred in 4 patients (24%), two of them (12%) required revision surgery for epidural hematoma. The success rate was 94%; one patient required revision surgery for recurrent SDAVF. Better neurological condition on admission (p=0.0098) and age >60 years (p=0.0498) were the factors associated with satisfactory outcome.
ConclusionsMicrosurgical closing of a SDAVF brings good and stable results over time. Aggressive treatment should be attempted even in cases of total loss of spinal cord function. Neurological condition before surgery and age may influence the outcome.
Keywords
Spinal dural arteriovenous fistula, Spinal vascular malformation, Surgery, Outcome, Complications
About this articleTitle
Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors
Journal
Neurologia i Neurochirurgia Polska
Issue
Pages
446-453
Page views
185
Article views/downloads
344
DOI
10.1016/j.pjnns.2017.07.001
Bibliographic record
Neurol Neurochir Pol 2017;51(6):446-453.
Keywords
Spinal dural arteriovenous fistula
Spinal vascular malformation
Surgery
Outcome
Complications
Authors
Jakub Wojciechowski
Przemysław Kunert
Arkadiusz Nowak
Tomasz Dziedzic
Tomasz Czernicki
Katarzyna Wójtowicz
Kamil Leśniewski
Andrzej Marchel
