open access

Vol 51, No 6 (2017)
Original research articles
Submitted: 2017-03-01
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Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors

Jakub Wojciechowski, Przemysław Kunert, Arkadiusz Nowak, Tomasz Dziedzic, Tomasz Czernicki, Katarzyna Wójtowicz, Kamil Leśniewski, Andrzej Marchel
DOI: 10.1016/j.pjnns.2017.07.001
·
Neurol Neurochir Pol 2017;51(6):446-453.

open access

Vol 51, No 6 (2017)
Original research articles
Submitted: 2017-03-01

Abstract

Background and purpose

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.

Methods

Seventeen 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.

Results

In 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.

Conclusions

Microsurgical 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

Background and purpose

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.

Methods

Seventeen 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.

Results

In 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.

Conclusions

Microsurgical 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.

Get Citation

Keywords

Spinal dural arteriovenous fistula, Spinal vascular malformation, Surgery, Outcome, Complications

About this article
Title

Surgical treatment for spinal dural arteriovenous fistulas: Outcome, complications and prognostic factors

Journal

Neurologia i Neurochirurgia Polska

Issue

Vol 51, No 6 (2017)

Pages

446-453

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

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