Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain.
BACKGROUND
Clinical features and prognosis of sensory disturbance in spinal dural arteriovenous fistula (SDAVF) have not been well documented. Here we report long-term outcomes and detailed sensory evaluations of surgically treated SDAVF, including 14 patients with the craniocervical fistulas.


METHODS
Thirty-four consecutive patients with SDAVF treated at our institute during a period of 14 years were reviewed (mean age, 64.6 years; 67.6% men). Fistulas were located at the craniocervical junction in 14 patients (CC group) and in the thoracolumbar spine in 20 patients (TL group). In the CC group, six patients presented with subarachnoid hemorrhage. Fistulas were found incidentally in seven patients. One patient in the CC group and all patients in the TL group presented with progressive myelopathy. Most patients underwent microsurgery either alone (30 patients) or combined with embolization (3 patients). One patient was treated by embolization only. The follow-up ranged from 12 to 145 months (mean, 57 months).


RESULTS
All but one patient in the CC group had excellent surgical outcome. Most patients in the TL group stabilized or improved neurologically. Shorter duration before treatment indicated better gait recovery. Important, a few patients in the TL group suffered worsening or development of new pain, as well as lesser degree of improvement in gait and micturition. Spinal cord atrophy was correlated with clinical deterioration.


CONCLUSIONS
In craniocervical SDAVF, surgical treatment provides favorable long-term outcomes without risk of recurrence. In the thoracolumbar SDAVF, irreversible structural changes, such as spinal cord atrophy, may lead to poor recovery. Early diagnosis and treatment are thus warranted.
Shinoyama
Mizuya
M
Department of Neurosurgery, Kohnan Hospital, Sendai, Japan.
Endo
Toshiki
T
Takahash
Toshiyuki
T
Shimizu
Hiroaki
H
Takahashi
Akira
A
Suzuki
Michiyasu
M
Tominaga
Teiji
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000453:epidemiology; D019635:Neurosurgical Procedures / Q000009:adverse effects; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D011859:Radiography; D012189:Retrospective Studies; D012678:Sensation Disorders / Q000453:epidemiology; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D013995:Time; D016896:Treatment Outcome