Surgical Treatment of Spinal Dural Arteriovenous Fistula: Management and Long-Term Outcome in a Single-Center Series.
OBJECTIVE
To perform a retrospective chart review of surgically treated patients with spinal dural arteriovenous fistula (SDAVF), a rare disease but the most common vascular malformation of the spine, focusing on clinical characteristics and functional outcome during long-term follow-up.


METHODS
Between June 1990 and April 2012, 29 patients with SDAVFs were treated surgically in a single institution. Patient characteristics, time from onset of symptoms to treatment, radiologic features, treatment-related complications, and functional outcome were analyzed. Outcome was assessed according to the Aminoff-Logue scale during follow-up. Results of magnetic resonance imaging scans performed during long-term follow-up were correlated with functional outcome.


RESULTS
There were 3 female (10%) and 26 male (90%) patients with SDAVFs treated surgically. Mean age was 61 years ± 11. Location of the fistula was at the thoracic level in 20 patients (69%), at the lumbar level in 8 patients (28%), and at the sacral level in 1 patient (3%). Mean postoperative Aminoff-Logue scale scores regarding gait and micturition improved after treatment compared with preoperatively (P = 0.02; P = 0.03). After surgical treatment, 22 patients (76%) achieved improvement in neurologic symptoms. In 6 patients (21%), neurologic status was the same as preoperatively. In 1 patient (3%), neurologic status worsened. Medullary signal alteration of diagnostic magnetic resonance imaging scans did not correlate with functional outcome (P = 0.2). Mean follow-up time was 63 months ± 55. All SDAVFs were treated in a single session without recurrence during the long-term follow-up period.


CONCLUSIONS
Surgical treatment of SDAVFs is safe and effective and leads to an improvement of neurologic symptoms in most patients. Surgical treatment of SDAVFs also provides long-term stability.
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany. Electronic address: patrick.schuss@ukb.uni-bonn.de.
Patrick
P
Schuss
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Frederick H
FH
Daher
Department of Radiology, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Susanne
S
Greschus
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Hartmut
H
Vatter
Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Bonn, Germany.
Erdem
E
Güresir
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome
Long-term outcome; Spinal dural arteriovenous fistula; Surgical treatment