Tanaka Tatsuya, Yamane Fumitaka, Sashida Ryohei, Hirokawa Yu, Wakamiya Tomihiro, Michiwaki Yuhei, Shimoji Kazuaki, Suehiro Eiichi, Onoda Keisuke, Matsuno Akira, Morimoto Tadatsugu
Department of Neurosurgery, International University of Health and Welfare, Narita Hospital, 852 Hatakeda, Narita 2868520, Japan.
Department of Orthopedic Surgery, Faculty of Medicine, Saga University, Saga 849-8501, Japan.
J Clin Med. 2024 Jan 25;13(3):711. doi: 10.3390/jcm13030711.
Spinal dural arteriovenous fistula (SDAVF) is among the most common arterial shunt diseases typically found in middle aged or older men. Herein, we aimed to clarify the reasons for misdiagnoses and delayed diagnoses of SDAVF, determine how these affect prognoses, and establish how they can be prevented. We conducted a PubMed/MEDLINE literature search using "spinal dural arteriovenous fistula", "delayed diagnosis", "late diagnosis", and "misdiagnosis" terms. We identified 18 articles, including 965 SDAVF cases. Patients were predominantly males (71.8-100.0%) (mean age: 53.5-71.0 years). Misdiagnoses rates varied (17.5-100.0%) and encompassed many conditions. The mean time between early manifestations and confirmed diagnosis was approximately 10-15 months and from the first radiologic image revealing dural arteriovenous fistula (DAVF) features to diagnosis was 9.2-20.7 months. Posttreatment outcomes showed a significant improvement in motor functions, gait, and micturition, particularly in patients exhibiting preoperative symptoms over a short period. SDAVF is frequently misdiagnosed or subject to delayed diagnosis, causing poor clinical outcomes. SDAVF symptoms including progressive lower-limb weakness, paresthesia, and vesicorectal dysfunction are indications for spinal magnetic resonance imaging with subsequent spinal angiography, wherein DAVF is evidenced by extensive T2 hyperintensity and flow-void abnormalities. We reported a representative case with delayed diagnosis.
脊髓硬脊膜动静脉瘘（SDAVF）是最常见的动脉分流疾病之一，多见于中老年男性。在此，我们旨在阐明SDAVF误诊和延迟诊断的原因，确定其对预后的影响，并确定如何预防。我们使用“脊髓硬脊膜动静脉瘘”、“延迟诊断”、“晚期诊断”和“误诊”等术语在PubMed/MEDLINE数据库中进行了文献检索。我们共检索到18篇文章，包含965例SDAVF病例。患者以男性为主（71.8 - 100.0%）（平均年龄：53.5 - 71.0岁）。误诊率各不相同（17.5 - 100.0%），涵盖多种病症。早期症状出现至确诊的平均时间约为10 - 15个月，从首次影像学检查显示硬脊膜动静脉瘘（DAVF）特征到确诊的时间为9.2 - 20.7个月。治疗后的结果显示运动功能、步态和排尿功能有显著改善，尤其是术前症状出现时间较短的患者。SDAVF经常被误诊或延迟诊断，导致临床预后不佳。SDAVF的症状包括进行性下肢无力、感觉异常和膀胱直肠功能障碍，这些症状提示应进行脊髓磁共振成像检查，随后进行脊髓血管造影，其中DAVF可通过广泛的T2高信号和流空异常得以证实。我们报告了一例延迟诊断的典型病例。
