title: Clinical outcome of treatments for spinal dural arteriovenous fistulas: results of multivariate analysis and review of the literature.
abstract: METHODS
  This study was a case series study using a prospective single-institute database for the treatment of spinal dural arteriovenous fistulas (SDAVFs).
  
  
  OBJECTIVE
  To evaluate clinical factors that influence the neurological outcomes of treatment for SDAVFs, which were obtained from the analysis of 21 patients treated in our institution, and to provide management recommendations based on the review of former major clinical studies including our own reported over the past 2 decades.
  
  
  BACKGROUND
  Since 1977, when Kendall and Logue described the etiology of SDAVFs as hyperpressure of intrathecal veins due to an abnormal shunting from the arteries, treatment strategies have improved dramatically along with developments in neuroimaging, endovascular techniques and materials, and microsurgery based on the underlying pathophysiological process. However, therapeutic guidelines remain controversial.
  
  
  METHODS
  Patients treated for SDAVFs from 2000 to 2008 were eligible. Age, sex, level of shunting, initial symptom, duration of symptom, the treatment method, and clinical symptoms before and 6 months after treatment were investigated.
  
  
  RESULTS
  There were a total of 30 patients (18 male and 12 female), with a mean age of 59 years; 21 of them underwent treatment for the first time. We conducted a univariate analysis using a logistic regression model, on age, sex, the level of SDAVFs, duration of symptoms, symptom (sensory or paralysis), and gait function and micturition before treatment, and the intervention method were set as variables to investigate the risk factors for motor deficit 6 months after the treatment. Only gait function before treatment was correlated with the motor deficit 6 months after treatment (odds ratio = 10.0; 95% confidence interval = 1.28-78.11, P = 0.03).From these results, intervention at an early stage would be the key to a preferable outcome of the treatment for SDAVFs.
  
  
  CONCLUSIONS
  The clinical status before treatment significantly influenced the clinical outcome after the treatment.
authors.affiliation: Department of Orthopedic Surgery, Nagoya University, Nagoya City, Aichi, Japan. nwakao@med.nagoya-u.ac.jp
authors.forename: Norimitsu
authors.initials: N
authors.lastname: Wakao
authors.forename: Shiro
authors.initials: S
authors.lastname: Imagama
authors.forename: Zenya
authors.initials: Z
authors.lastname: Ito
authors.forename: Kei
authors.initials: K
authors.lastname: Ando
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hirano
authors.forename: Ryoji
authors.initials: R
authors.lastname: Tauchi
authors.forename: Akio
authors.initials: A
authors.lastname: Muramoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsui
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Matsuyama
authors.forename: Naoki
authors.initials: N
authors.lastname: Ishiguro
mesh_terms: D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D016022:Case-Control Studies; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome