Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study

ObjectiveTo define the pattern of long-term clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas (SDAVFs).DesginProspective cohort study based on constantly recruiting patients with SDAVFs in two medical centres in China.SettingPatients with SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centres.ParticipantsA prospective cohort of 94 patients with SDAVFs was included in this study, and 86 patients (mean age 53.0 years, 71 men) completed the study. Patients who had previously undergone endovascular or neurosurgical treatment or had neurological dysfunction caused by other diseases or refused treatment were excluded.InterventionsAll patients underwent neurosurgery or endovascular embolisation. These patients were evaluated with the modified Aminoff and Logue’s Scale (mALS) 1 day before and 3, 6, 12 and 72 months after treatments.ResultsThe duration of symptoms ranged from 0.5 to 66 months (average 12.8 months). The location of SDAVFs was as follows: 33.7% above T7, 50.0% between/include T7 and T12% and 16.3% below T12. 75 patients (87.2%) underwent neurosurgical treatment, and 9 patients (10.5%) underwent endovascular treatment. 58 patients (67.4%) exhibited an improvement in mALS of one point or greater at 72 months. Patients with less disability were more likely to improve at 72 months (p<0.05). 48 patients (55.8%) showed deterioration at 72 months compared with 12 months. 61% of the patients suffered numbness, and 22% had pain before treatment. However, 81% of patients had numbness, and 28% had pain after treatment. This deterioration was related to 1-year mALS and age.ConclusionNearly two-thirds of the patients experienced clinical improvement at 72 months, and preoperative (1 day before treatment) mALS was the strongest predictor of clinical improvement. However, 55.8% of patients showed deterioration after temporary recovery. All patients with SDAVFs should accept treatment as soon as possible.

The Bilateral Sacral Origin of a Spinal Dural Arteriovenous Fistula: A Case Report

: Spinal dural arteriovenous fistulas (SDAVFs) are characterized by an abnormal connection between a spinal radicular artery and a perimedullary vein, mainly fed by a radicular artery at the nerve root sleeve. Here, we describe the case of a 40-year-old woman, presenting with progressive weakness of the lower extremities and the sphincter. Thoracic magnetic resonance imaging (MRI) showed spinal cord edema and signal voids on the dorsal surface of the cord. Spinal angiography demonstrated a SDAVF with a nidus at the sacral level; the feeder of the arteriovenous fistula was a lateral sacral artery, as a branch of the internal iliac artery. The lateral sacral artery was subselectively catheterized, and SDAVF was embolized with 25% n-butyl cyanoacrylate (NBCA) glue (glue: lipiodol ratio, 1:3). After embolization, no definite residual connection was visualized between the arterial and venous systems.

Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

The full text of this preprint has been withdrawn by the authors due to author disagreement with the posting of the preprint. Therefore, the authors do not wish this work to be cited as a reference. Questions should be directed to the corresponding author.

Spinal Dural Arteriovenous Fistulas (FAVDR) with Peri- Medullary Venous Drainage: Clinical, Radiological and Therapeutic Aspects (Case Report and Literature Review)

Spinal dural arteriovenous fistulas are rare and often unrecognized, they occur predominantly in men, with an initial clinical picture most often misleading made of chronic myelopathy in the absence of treatment, the evolution is slowly towards a definitive paraplegia. We report the case of a patient referred for a table of spinal cord compression revealing a spinal dural fistula with perimedullary venous drainage treated urgently, due to the worsening of the clinical picture. The standard treatment consists of surgical or endovascular exclusion of the fistula (in our case the fistula was surgically excluded). From this case and based on the literature, we will specify the a, clinical, radiological characteristics as well as the prognosis of these malformations, and we will discuss the possibilities of therapeutic management.

Modified Borden Grading System For Cranial And Spinal Dural Arteriovenous Fistulas In Neuroendovsacular Era

Objective:Dural arteriovenous fistulas (DAVFs) is a complex condition in neurovascular surgery. Many DAVF classifications have been reported and have changed over time in the literatures. The purposes of this study was to propose a practical and easy-to-follow grading system for DAVFs.Methods: From a retrospective analysis of our database, 143 DAVF patients were consecutively collected. Patients were grouped into modified Borden types I, II and III. Patients’ characteristics, treatment and outcomes were analyzed between 3 types. Patients’ pre-treatment status(pre-mRS) were analyzed between Borden, Cognard and modified Borden grading systems. Results:Male and non-sinus locations were statistically significantly correlated with the type III DAVF type (p<0.001). More than 3 pedical suppliers and pial arterial suppliers were associated with high grade (type II and III) DAVFs(p=0.003). Worse symptoms were present in most type II and type III patients(p<0.001). Type III DAVF was associated with TAE and type II DAVF was associated with TVE treatment modalities(p<0.001). The results of one-way ANOVA indicated that pre-mRS was significantly different within modified Borden types and Cognard types (p = 4.3×10-6 and p = 1×10-4, respectively). In terms of pre-mRS, patients were not separated well using Cognard grading systems.Conclusions: A modified grading system of cerebral and spinal DAVFs was promoted according to understanding of angioarchitectures in order to evaluate risk of DAVFs and guide the therapies of these lesions. The modified Borden grading system was informative by providing an effective assessment for the risk of patients with simple but precise results.

Intracranial Subarachnoid Haemorrhage Caused by Cervical Spinal Dural Arteriovenous Fistulas: Case Report

Cervical spinal vascular abnormalities commonly present with progressive myelopathy as a result of venous congestion. They are not very prone to bleed and tend to be underdiagnosed due to their subtle clinical presentation. We came across a rare case of intracranial subarachnoid haemorrhage caused by cervical spinal dural fistula in the Imperial College Healthcare NHS Trust Hospitals/UK in June 2020. We diagnosed the patient under strict evidence base medicine guidance, which otherwise would have been missed. We discussed the case in several multidisciplinary team (MDT) meetings, and patient was treated under the joint care of the neurology and neurosurgical teams. Patient made a full recovery and discharged home with no neurological defects or complications. Here, we reported this case with all the evidence we gathered from our MDT discussion. We hope our experience would help improve the diagnosis and management protocol for future patients with a similar condition.