title: Clinical features and outcomes of spinal cord arteriovenous malformations: comparison between nidus and fistulous types.
abstract: OBJECTIVE
  As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus- and fistulous-type spinal cord AVMs.
  
  
  METHODS
  Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed.
  
  
  RESULTS
  Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment.
  
  
  CONCLUSIONS
  Nidus and fistulous spinal cord AVMs have different clinical features and obliteration rates, which may affect their long-term prognosis.
authors.affiliation: From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.).
authors.forename: Young-Jun
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.).
authors.forename: Karel G
authors.initials: KG
authors.lastname: Terbrugge
authors.affiliation: From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.).
authors.forename: Guillaume
authors.initials: G
authors.lastname: Saliou
authors.affiliation: From the Department of Medical Imaging (Y.-J.L., K.G.T., G.S., T.K.), and Division of Neurosurgery (T.K.), Toronto Western Hospital, University of Toronto, Ontario, Canada; Department of Radiology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea (Y.-J.L.); and Service de Neuroradiologie, CHU Bicêtre, Le Kremlin Bicêtre Cedex, France (G.S.). Timo.Krings@uhn.ca.
authors.forename: Timo
authors.initials: T
authors.lastname: Krings
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000175:diagnosis* / Q000628:therapy; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000628:therapy; D002648:Child; D018450:Disease Progression; D004621:Embolization, Therapeutic; D005260:Female; D006470:Hemorrhage / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D013116:Spinal Cord / Q000503:physiopathology*; D013118:Spinal Cord Diseases / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: arteriovenous malformations; embolization; spinal cord; surgery; treatment outcome