Filis Andreas, Romualdo Sergio M F, Engellandt Kay, El-Battrawy Ibrahim, Podlesek Dino, Juratli Tareq A, Eyüpoglu Ilker Y, Schackert Gabriele, Hijazi Mido Max
Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Dresden, Germany.
Institute of Diagnostic and Interventional Neuroradiology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Dresden, Germany.
Front Surg. 2024 Mar 5;11:1374321. doi: 10.3389/fsurg.2024.1374321. eCollection 2024.
Spinal dural arteriovenous fistulas (SDAVFs) are rare spinal vascular malformations, but account for 70 to 80% of all spinal arteriovenous malformations. SDAVFs can be treated either surgically or endovascularly, with surgical treatment appearing to lead to higher closure rates. Our aim was to analyze the demographic data, diagnostic history, treatment characteristics and clinical short- and long-term outcomes.
The medical records of 81 patients who underwent surgical ( = 70, 86.4%) and endovascular ( = 11, 13.6%) treatment for SDAVF at a university hospital between 2002 and 2023 were retrospectively analyzed.
SDAVF was observed more frequently in men than women (61, 75.3% vs. 20, 24.7%) with a mean age of 63.5 ± 12.7 years and a mean duration of symptoms to diagnosis of 12.0 ± 12.8 months. The most common first symptom was gait disturbance (36, 44.4%), followed by sensory disturbance (24, 29.6%). The location of the fistula point was most common in the lower thoracic region (36, 44.5%), followed by the lumbar region (23, 28.4%). Incomplete or failed occlusion of the fistula occurred in 8 patients (9.9%), with 6 patients (7.4%) undergoing further treatment either surgically or endovascularly. Treatment- or hospital-related complications were observed in 16 patients (19.8%). A single-level laminectomy was the most common approach (31, 44.3%), followed by single-level hemilaminectomy (28, 40.0%), and unilateral interlaminar fenestration (11, 15.7%). Back pain or radiculopathy was observed in 58% of patients (47/81) pre-treatment and had already decreased to 24.7% at hospital discharge ( < 0.001). No significant differences were observed in sensory disturbances ( = 0.681). The median of American Spinal Injury Association motor score (ASIA-MS) was 94 [82.5-100] at admission, 98 [86.5-100] at hospital discharge, 100 [90-100] at the first, second, and third follow-up ( = 0.019). The median modified Aminoff-Logue scale (mALS) was 5 [2-7] at admission, 3 [1-6] at hospital discharge, 2 [1-5] at the first follow-up, 2 [0.5-5] at the second follow-up and 2 [1-7] at the third follow-up ( = 0.006).
SDAVF occurs predominantly in men in the 6th decade of life and can be safely and effectively treated surgically and endovascularly, improving symptoms such as pain and motor deficits, gait disturbances as well as bowel and bladder dysfunction, but not sensory disturbances.
脊髓硬脊膜动静脉瘘（SDAVF）是一种罕见的脊髓血管畸形，但占所有脊髓动静脉畸形的70%至80%。SDAVF可通过手术或血管内治疗，手术治疗的闭合率似乎更高。我们的目的是分析人口统计学数据、诊断史、治疗特征以及临床短期和长期结果。
回顾性分析了2002年至2023年间在一家大学医院接受SDAVF手术治疗（n = 70，86.4%）和血管内治疗（n = 11，13.6%）的81例患者的病历。
SDAVF在男性中比女性更常见（61例，75.3%对20例，24.7%），平均年龄为63.5±12.7岁，从出现症状到诊断的平均时间为12.0±12.8个月。最常见的首发症状是步态障碍（36例，44.4%），其次是感觉障碍（24例，29.6%）。瘘口点的位置最常见于下胸段（36例，44.5%），其次是腰段（23例，28.4%）。8例患者（9.9%）出现瘘口不完全闭塞或闭塞失败，6例患者（7.4%）接受了进一步的手术或血管内治疗。16例患者（19.8%）出现了与治疗或医院相关的并发症。单节段椎板切除术是最常见的手术方式（31例，44.3%），其次是单节段半椎板切除术（28例，40.0%）和单侧椎间孔切开术（11例，15.7%）。58%的患者（47/81）在治疗前出现背痛或神经根病，出院时已降至24.7%（P < 0.001）。感觉障碍方面未观察到显著差异（P = 0.681）。美国脊髓损伤协会运动评分（ASIA-MS）的中位数在入院时为94[82.5 - 100]，出院时为98[86.5 - 100]，在第一次、第二次和第三次随访时为100[90 - 100]（P = 0.019）。改良阿明诺夫-洛格量表（mALS）的中位数在入院时为5[2 - 7]，出院时为3[1 - 6]，第一次随访时为2[1 - 5]，第二次随访时为2[0.5 - 5]，第三次随访时为2[1 - 7]（P = 0.006）。
SDAVF主要发生于60岁左右的男性，手术和血管内治疗均可安全有效地进行，可改善疼痛、运动功能障碍、步态障碍以及肠道和膀胱功能障碍等症状，但对感觉障碍无改善。
