title: Single center experience with treatment of spinal dural arteriovenous fistulas.
abstract: Spinal dural arteriovenous fistulas (SDAVFs) are rare pathologies with a yearly incidence of 5-10 new cases/million, constituting 60-80 % of spinal arteriovenous malformations. Clinical symptoms include progressive paraparesis, paresthesias, bladder, and bowel disturbances. The pathophysiology of SDAVFs is not well elucidated. Microneurosurgery and endovascular techniques are established treatment modalities for permanent fistula occlusion, which are oftentimes accompanied by an amelioration of neurological deficits in the long run. Here, we report our interdisciplinary neurosurgical/neuroradiological management strategy of SDAVFs in 32 patients who were evaluated retrospectively. We focused on clinical presentation, microneurosurgical and interventional technique, early, and late neurological results. Quality of life (QoL) was additionally assessed in 12 patients at last follow-up. We discuss the results against the background of the current literature. Our series and the literature indicate that clinical outcome after treatment of SDAVF is favorable in general. Both neurosurgical and neurointerventional therapies appear to be safe and effective, but short-term neurological deterioration after the intervention constitutes an as-of-yet unsolved problem. Beyond age and preoperative neurological state, presence of comorbidities had a significant influence on neurological outcome in our study sample. Self-assessed physical and mental QoL at long-term follow-up was reduced in quite a number of patients and was associated with a poorer neurological result as well as presence of comorbidities. The patients' perspective in terms of QoL was first investigated in this study, but further research on QoL and psychosocial impairment of SDAVF patients is needed to enable individualized counseling and rehabilitation strategies.
authors.affiliation: Department of Neurosurgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, Germany, neriman.oezkan@uk-essen.de.
authors.forename: Neriman
authors.initials: N
authors.lastname: Özkan
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
authors.forename: Sophia Luise
authors.initials: SL
authors.lastname: Goerike
authors.forename: Karsten Henning
authors.initials: KH
authors.lastname: Wrede
authors.forename: Bernadette
authors.initials: B
authors.lastname: Kleist
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Stein
authors.forename: Oliver
authors.initials: O
authors.lastname: Gembruch
authors.forename: Ibrahim Erol
authors.initials: IE
authors.lastname: Sandalcioglu
authors.forename: Isabel
authors.initials: I
authors.lastname: Wanke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020785:Central Nervous System Vascular Malformations / Q000523:psychology / Q000601:surgery*; D002548:Cerebral Revascularization / Q000009:adverse effects / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D013122:Spinal Diseases / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome