Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Evidence-based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
BMJ Open. 2022 Jan 3;12(1):e047390. doi: 10.1136/bmjopen-2020-047390.
To define the pattern of long-term clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas (SDAVFs).
Prospective cohort study based on constantly recruiting patients with SDAVFs in two medical centres in China.
Patients with SDAVFs were recruited consecutively between March 2013 and December 2014 in two referral centres.
A prospective cohort of 94 patients with SDAVFs was included in this study, and 86 patients (mean age 53.0 years, 71 men) completed the study. Patients who had previously undergone endovascular or neurosurgical treatment or had neurological dysfunction caused by other diseases or refused treatment were excluded.
All patients underwent neurosurgery or endovascular embolisation. These patients were evaluated with the modified Aminoff and Logue's Scale (mALS) 1 day before and 3, 6, 12 and 72 months after treatments.
The duration of symptoms ranged from 0.5 to 66 months (average 12.8 months). The location of SDAVFs was as follows: 33.7% above T7, 50.0% between/include T7 and T12% and 16.3% below T12. 75 patients (87.2%) underwent neurosurgical treatment, and 9 patients (10.5%) underwent endovascular treatment. 58 patients (67.4%) exhibited an improvement in mALS of one point or greater at 72 months. Patients with less disability were more likely to improve at 72 months (p<0.05). 48 patients (55.8%) showed deterioration at 72 months compared with 12 months. 61% of the patients suffered numbness, and 22% had pain before treatment. However, 81% of patients had numbness, and 28% had pain after treatment. This deterioration was related to 1-year mALS and age.
Nearly two-thirds of the patients experienced clinical improvement at 72 months, and preoperative (1 day before treatment) mALS was the strongest predictor of clinical improvement. However, 55.8% of patients showed deterioration after temporary recovery. All patients with SDAVFs should accept treatment as soon as possible.
定义脊髓硬膜动静脉瘘（SDAVF）患者的长期临床结局和预后因素模式。
在中国的两个医学中心，基于连续招募 SDAVF 患者的前瞻性队列研究。
2013 年 3 月至 2014 年 12 月，在两个转诊中心连续招募 SDAVF 患者。
本研究纳入了 94 例 SDAVF 患者的前瞻性队列，其中 86 例患者（平均年龄 53.0 岁，71 名男性）完成了研究。先前接受过血管内或神经外科治疗或因其他疾病导致神经功能障碍或拒绝治疗的患者被排除在外。
所有患者均接受神经外科或血管内栓塞治疗。这些患者在治疗前 1 天、治疗后 3、6、12 和 72 个月时使用改良的 Aminoff 和 Logue 量表（mALS）进行评估。
症状持续时间为 0.5 至 66 个月（平均 12.8 个月）。SDAVF 的位置如下：33.7%位于 T7 以上，50.0%位于 T7 至 T12%之间/包括 T7 和 T12%，16.3%位于 T12 以下。75 例（87.2%）患者接受神经外科治疗，9 例（10.5%）患者接受血管内治疗。72 个月时，58 例（67.4%）患者 mALS 改善 1 分或以上。mALS 评分较低的患者在 72 个月时更有可能改善（p<0.05）。与 12 个月时相比，48 例（55.8%）患者在 72 个月时出现恶化。61%的患者有麻木感，22%的患者在治疗前有疼痛。然而，治疗后 81%的患者有麻木感，28%的患者有疼痛。这种恶化与 1 年 mALS 和年龄有关。
近三分之二的患者在 72 个月时出现临床改善，术前（治疗前 1 天）mALS 是临床改善的最强预测因素。然而，55.8%的患者在暂时恢复后出现恶化。所有 SDAVF 患者都应尽快接受治疗。
