title: Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula.
abstract: Spinal dural arteriovenous fistula (SDAVF) is a relatively common acquired vascular malformation of the spinal cord. Assessment of a SDAVF is often difficult because of non-specific findings on non-invasive imaging modalities. Diagnosis of a SDAVF is often delayed, and some patients receive unnecessary treatment and treatment delays, often resulting in a poor outcome. The aim of this study was to characterize the clinical presentation, typical imaging findings, and long-term outcome of SDAVF. Forty patients (13 women, 27 men; mean age 58.18 ± standard deviation 14.75 years) who were treated at our hospital from June 1992 to March 2014 were retrospectively reviewed. We investigated the baseline characteristics, clinical presentation, imaging findings, treatment modalities, and outcome of the patients. The most common clinical presentation was a sensory symptom (80%), followed by motor weakness (70%), and sphincter dysfunction (62.5%). Roughly one-third (32.5%) of patients had a stepwise progression of fluctuating weakness and sensory symptoms, but the most common presentation was chronic progressive myelopathic symptoms (47.5%). Thirty-four patients (85%) had T2 signal change on the spinal cord MRI, indicative of cord edema. Thirty-eight patients had typical perimedullary vessel flow voids on T2-weighted MRI. Twenty-eight patients were treated with endovascular embolization, five patients underwent surgery, and four patients underwent both. Clinical outcome was determined by severity of initial deficit (p=0.008), extent of cord edema (p=0.010), treatment failure (p=0.004), and a residual fistula (p=0.017). SDAVF causes a treatable myelopathy, so early diagnosis and intervention is essential.
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Jookyung
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea.
authors.forename: Young-Min
authors.initials: YM
authors.lastname: Lim
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Dae Chul
authors.initials: DC
authors.lastname: Suh
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Rhim
authors.affiliation: Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43 Gil, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: kkkim@amc.seoul.kr.
authors.forename: Kwang-Kuk
authors.initials: KK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000628:therapy; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000473:pathology* / Q000628:therapy; D017211:Treatment Failure
keywords: Clinical outcome; Magnetic resonance imaging; Spinal dural arteriovenous fistula