Özkan Neriman, Kreitschmann-Andermahr Ilonka, Goerike Sophia Luise, Wrede Karsten Henning, Kleist Bernadette, Stein Klaus-Peter, Gembruch Oliver, Sandalcioglu Ibrahim Erol, Wanke Isabel, Sure Ulrich
Department of Neurosurgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, Germany,
Neurosurg Rev. 2015 Oct;38(4):683-92. doi: 10.1007/s10143-015-0645-z. Epub 2015 Jul 17.
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.
脊髓硬脊膜动静脉瘘（SDAVF）是一种罕见的疾病，年发病率为每百万人口中有5 - 10例新发病例，占脊髓动静脉畸形的60 - 80%。临床症状包括进行性下肢轻瘫、感觉异常、膀胱和肠道功能障碍。SDAVF的病理生理学尚未完全阐明。显微神经外科手术和血管内技术是用于永久性闭塞瘘口的既定治疗方式，从长远来看，这些治疗方式常常伴随着神经功能缺损的改善。在此，我们报告我们对32例患者的SDAVF进行的跨学科神经外科/神经放射学管理策略，这些患者进行了回顾性评估。我们关注临床表现、显微神经外科手术和介入技术、早期和晚期神经学结果。在最后一次随访时，还对12例患者的生活质量（QoL）进行了评估。我们结合当前文献讨论了结果。我们的系列研究和文献表明，一般来说，SDAVF治疗后的临床结果是良好的。神经外科和神经介入治疗似乎都是安全有效的，但干预后短期神经功能恶化仍是一个尚未解决的问题。在我们的研究样本中，除了年龄和术前神经状态外，合并症的存在对神经学结果有显著影响。在相当多的患者中，长期随访时自我评估的身体和心理QoL降低，并且与较差的神经学结果以及合并症的存在相关。本研究首次调查了患者对QoL的看法，但需要对SDAVF患者的QoL和社会心理损害进行进一步研究，以制定个性化的咨询和康复策略。
