Recovery from paraplegia after the treatment of spinal dural arteriovenous fistula: case report and review of the literature.
BACKGROUND
Spinal dural arteriovenous fistula (SDAVF) is a rare and enigmatic disease. Functional outcome is particularly uncertain for the small group of patients that are unable to stand at the time of diagnosis (grade 5 gait disturbance on the Aminoff-Logue scale, ALS). The objective of this study is to examine the final functional outcome of patients with SDAVF in grade 5 gait ALS before treatment.


METHODS
We conducted a PubMed search using the keyword "spinal dural arteriovenous fistula." A review of the clinical series and single well-detailed case reports of SDAVF gathered 106 patients with grade 5 gait ALS on the initial examination. Additionally, we report the case of a 56-year-old man presenting acute paraplegia and urinary retention on admission who had complained of sporadic motor and sphincter disturbances for 1 year. Spine T2-weighted MR imaging showed a central hyperintensity within the spinal cord, and the angiography demonstrated a T-11 SDAVF. Interruption of the fistula was performed through an urgent one-level laminectomy.


RESULTS
Grade 5 gait ALS was present in 25% of the patients with SDAVF included in the clinical series. Latest follow-up showed that gait disturbance improved in 73% of patients after treatment, although less than 6% became grade 1 gait ALS. Micturition disturbances improved in 39%. Exploration of our patient showed improvement to grade 1 gait ALS 1 year after the surgical treatment.


CONCLUSIONS
Interruption of SDAVF in paraplegic patients may improve the final functional gait outcome in some cases. No complete recovery (grade 0 gait ALS) was achieved after treatment. Micturition disturbances had a worse prognosis than motor deficits.
Prieto
Ruth
R
Department of Neurosurgery, Clinico San Carlos University Hospital, 28040 Madrid, Spain. rprieto@iib.uam.es
Pascual
Jose M
JM
Gutiérrez
Raquel
R
Santos
Enrique
E
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology*; D013118:Spinal Cord Diseases / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome