Long-term outcome in the repair of spinal cord perimedullary arteriovenous fistulas.
OBJECTIVE
The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated at a single tertiary care institution.


METHODS
We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS.


RESULTS
Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1-228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively).


CONCLUSIONS
Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted.
Antonietti
L
L
Departments of Radiology, University of California San Francisco, USA.
Sheth
S A
SA
Halbach
V V
VV
Higashida
R T
RT
Dowd
C F
CF
Lawton
M T
MT
English
J D
JD
Hetts
S W
SW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures; D055815:Young Adult
Neurology. 1987 Jun;37(6):969-79
3587648
J Neurol Neurosurg Psychiatry. 2003 Oct;74(10):1438-40
14570843
Eur Radiol. 2005 Feb;15(2):267-78
15538580
AJNR Am J Neuroradiol. 1997 Apr;18(4):677-87
9127029
Brain. 1974 Mar;97(1):197-210
4373119
J Neurosurg. 1993 Jul;79(1):16-27
8315463
Neurosurgery. 2005 Nov;57(5):973-83; discussion 973-83
16284566
J Neurosurg. 1999 Apr;90(2 Suppl):198-205
10199249
Neurosurgery. 1993 Jun;32(6):885-91; discussion 891
8327088
J Neurosurg. 1994 Aug;81(2):221-9
8027805
J Neuroradiol. 1980;7(4):271-320
7276996
J Neurol Sci. 1974 Oct;23(2):255-63
4279276
Neurology. 2004 May 25;62(10):1839-41
15159489
Neurosurgery. 2008 Jan;62(1):159-66; discussion 166-7
18300903
J Neurosurg. 1986 Jan;64(1):134-9
3941336
J Neurol. 2006 Feb;253(2):159-62
16222429
Surg Neurol. 1977 Aug;8(2):85-93
888091
Neurosurgery. 1993 Dec;33(6):972-9; discussion 979-80
8134010
Neurosurgery. 2005 Feb;56(2):232-41; discussion 232-41
15670371