title: Spinal dural arterio-venous fistula: clinico-radiological profile and outcome following surgical occlusion in an Indian neurosurgical center.
abstract: BACKGROUND
  Spinal dural arteriovenous fistula (SDAVF) is a common type of spinal vascular lesion. However, there has not been any published study on its clinico-radiological characteristics or surgical outcome from India.
  
  
  OBJECTIVE
  The aim of this study was to determine the clinico-radiological features of patients with SDAVF, outcomes following surgical ligation of the fistula and the various factors involved.
  
  
  METHODS
  Patients who were operated for SDAVF were studied for demographic details, symptoms, clinical severity, radiological features and neurological outcome in the form of improvement in gait disability grades. Appropriate statistical tests were performed.
  
  
  RESULTS
  There were 22 (19 males, 3 females) patients of SDAVF who underwent surgical ligation with a mean age of 55 years. The mean duration of symptoms at presentation was 15 months. Three patients had acute onset while the rest had insidious onset of symptoms. Out of the 22 patients, 11 (50%) had motor weakness as the first symptom, 13 (59%) were bedridden and 19 (86.4%) had bladder involvement at presentation. Thirteen patients had fistulae in thoracic spine, whereas eight had fistulae in the lumbar spine. All had a favorable outcome in the form of at least non-progression of gait disability (14 had improvement while 8 had stabilized). The improvement was non-significantly associated with younger age, acute onset, ambulant status and fistula below T9. It was inversely associated with pain as the first symptom and fluctuant clinical course.
  
  
  CONCLUSIONS
  Surgical occlusion of SDAVF is usually associated with either improvement or stabilization of motor weakness.
authors.affiliation: Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sivashanmugam
authors.initials: S
authors.lastname: Dhandapani
authors.forename: Aditya
authors.initials: A
authors.lastname: Gupta
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Singh
authors.forename: B S
authors.initials: BS
authors.lastname: Sharma
authors.forename: A K
authors.initials: AK
authors.lastname: Mahapatra
authors.forename: V S
authors.initials: VS
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006801:Humans; D007194:India; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000379:methods*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome