title: Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformation: clinical article.
abstract: OBJECTIVE
  Spinal vascular diseases, such as spinal dural arteriovenous fistulas (DAVFs), perimedullary arteriovenous fistulas (AVFs), and spinal arteriovenous malformations (AVMs), are very rare. The authors analyzed the features and treatment outcomes of these conditions.
  
  
  METHODS
  Data from 64 patients were retrospectively reviewed. There were 33 spinal DAVFs (1 patient had 2 lesions), 20 perimedullary AVFs, and 12 spinal AVMs. Clinical features, radiological findings, treatment results, and clinical outcomes were evaluated according to the diseases, subtypes, and treatment modalities. The median duration of follow-up was 20, 42, and 56 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively.
  
  
  RESULTS
  Spinal DAVFs showed faster progression of symptoms (median 5, 12, and 36 months for spinal DAVFs, perimedullary AVFs, and spinal AVMs, respectively) and worse neurological status at diagnosis (poor neurological status in 56%, 65%, and 33%, respectively). On MRI, signal voids were demonstrated in all except 1 spinal DAVF. At the last follow-up, 94% of spinal DAVFs, 68% of perimedullary AVFs, and 50% of spinal AVMs were completely obliterated. Favorable clinical outcomes were achieved in 91%, 95%, and 58%, respectively. In detail, the majority (78%) of spinal DAVFs were embolized, resulting in complete obliteration in 92% and favorable clinical outcomes in 92%. Most Type IVa and IVb perimedullary AVFs were surgically treated (71% and 88%), with complete obliterations of 86% and 71%, and favorable clinical outcomes in 100% and 86%, respectively. All Type IVc lesions were embolized with a low cure rate of 40%; however, clinical outcomes were satisfactory. Spinal AVMs were generally embolized (67%), and only glomus-type lesions attained a satisfactory cure rate (80%) and clinical outcome (100%).
  
  
  CONCLUSIONS
  Embolization produced satisfactory outcomes in spinal DAVFs and glomus-type spinal AVMs. Surgery is advantageous in Type IVa and IVb perimedullary AVFs. Palliative embolization can be effective in Type IVc perimedullary AVFs and juvenile spinal AVMs.
authors.affiliation: Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Gangwon-do, Korea.
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.forename: Ki-Jeong
authors.initials: KJ
authors.lastname: Kim
authors.forename: O-Ki
authors.initials: OK
authors.lastname: Kwon
authors.forename: Chi Heon
authors.initials: CH
authors.lastname: Kim
authors.forename: Jiha
authors.initials: J
authors.lastname: Kim
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000473:pathology / Q000601:surgery / Q000628:therapy; D001165:Arteriovenous Malformations / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020758:Spinal Cord Vascular Diseases / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult