scholarly journals Clinical Outcomes of Patients with Delayed Diagnosis of Spinal Dural Arteriovenous Fistulas

2015 ◽  
Vol 37 (2) ◽  
pp. 380-386 ◽  
Author(s):  
W. Brinjikji ◽  
D.M. Nasr ◽  
J.M. Morris ◽  
A.A. Rabinstein ◽  
G. Lanzino
Keyword(s):  
Clinical Outcomes ◽  
Delayed Diagnosis ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

scholarly journals Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas : a prospective cohort study in two Chinese centres

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019800 ◽  
Author(s):  
Yongjie Ma ◽  
Sichang Chen ◽  
Chao Peng ◽  
Chunxiu Wang ◽  
Guilin Li ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Prospective Cohort ◽  
Short Term ◽  
Duration Of Symptoms ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Neurosurgical Treatment ◽  
Spinal Dural Arteriovenous Fistulas

BackgroundThe short-term outcomes and prognostic factors of patients with spinal dural arteriovenous fistulas (SDAVFs) have not been defined in large cohorts.ObjectiveTo define the short-term clinical outcomes and prognostic factors in patients with SDAVFs.MethodsA prospective cohort of 112 patients with SDAVFs were included consecutively in this study. The patients were serially evaluated with the modified Aminoff and Logue’s Scale (mALS) one day before surgery and at 3 months, 6 months and 12 months after treatment. Univariate and multivariate analyses were performed to identify demographic, clinical and procedural factors related to favourable outcome.ResultsA total of 94 patients (mean age 53.5 years, 78 were men) met the criteria and are included in the final analyses. Duration of symptom ranged from 0.5 to 66 months (average time period of 12.7 months). The location of SDAVFs was as follows: 31.6% above T7 level, 48.4% between T7 and T12 level (including T7 and T12) and 20.0% below T12 level. A total of 81 patients (86.2%) underwent neurosurgical treatment, 10 patients (10.6%) underwent endovascular treatment, and 3 patients (3.2%) underwent neurosurgical treatment after unsuccessful embolisation. A total of 78 patients demonstrated an improvement in mALS score of one point or greater at 12 months. Preoperative mALS score was associated with clinical improvement after adjusting for age, gender, duration of symptoms, location of fistula and treatment modality using unconditional logistic regression analysis (p<0.05).ConclusionApproximately four fifths of the patients experienced clinical improvement at 12 months and preoperative mALS was the strongest predictor of clinical improvement in the cohort.

Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes

2011 ◽  
Vol 14 (4) ◽  
pp. 548-554 ◽  
Author(s):  
Timothy J. Kaufmann ◽  
Jonathan M. Morris ◽  
Andrea Saladino ◽  
Jay N. Mandrekar ◽  
Giuseppe Lanzino
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Clinical Outcomes ◽  
Imaging Findings ◽  
Urinary Function ◽  
Arteriovenous Fistulas ◽  
Imaging Characteristics ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Object Little information is available on follow-up MR imaging after treatment of spinal dural arteriovenous fistulas (DAVFs). The authors studied MR imaging findings in treated spinal DAVFs in relation to clinical outcomes. Methods A retrospective review of patients with spinal DAVFs who had undergone both pre- and postoperative spinal MR imaging was conducted. Postoperative MR images were obtained as routine follow-up studies or because of subjective or objective clinical deterioration. Several pre- and posttreatment MR imaging characteristics were evaluated by 2 neuroradiologists blinded to the clinical outcome. Clinical outcomes of motor, sensory, and urinary function (in relation to the patient's preoperative status) at the time of the postoperative MR imaging were obtained from the clinical record. The chi-square, Fisher exact, and rank-sum tests were performed to correlate imaging findings and changes with clinical outcomes. Results Thirty-four patients met inclusion criteria. Treatment was surgical in 33 patients and endovascular in 1 patient. Follow-up MR imaging was performed at a mean 168 ± 107 days after treatment. Twenty-seven patients (79.4%) were either clinically stable or improved, and 7 (20.6%) experienced worsening in one or more clinical outcomes. Most patients were found to have improvement of MR imaging changes. However, some degree of persistent spinal cord signal abnormality, enhancement, and swelling was observed in 31 (91.2%), 29 (85.3%), and 18 (52.3%) patients, respectively. Changes in these MR imaging characteristics compared with preoperative MR imaging did not correlate with clinical outcomes (p > 0.05), with the one exception of a significant correlation between change in urinary function and extent of spinal cord contrast enhancement (p = 0.026), a correlation of uncertain importance. Ten of the 34 patients underwent posttreatment digital subtraction angiography, and 3 of these patients had recurrent/residual DAVFs. Worsening of motor function significantly correlated with recurrent/residual DAVF (p = 0.053). Conclusions Spinal cord abnormalities persist on postoperative MR imaging studies in patients with treated spinal DAVFs, and although they tend to mildly improve with time, these changes may not correlate with clinical outcomes. However, regardless of imaging findings, worsening motor function may correlate with a recurrent or residual DAVF.

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

2012 ◽  
Vol 32 (5) ◽  
pp. E17 ◽  
Author(s):  
Jennifer E. Fugate ◽  
Giuseppe Lanzino ◽  
Alejandro A. Rabinstein
Keyword(s):  
Spinal Cord ◽  
Clinical Symptoms ◽  
Neurological Deficits ◽  
Intramedullary Spinal Cord ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Signal Abnormality ◽  
Dural Arteriovenous Fistulas ◽  
Sensory Disturbances ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

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