Imaging characteristics, misdiagnosis and microsurgical outcomes of patients with spinal dural arteriovenous fistula: a retrospective study of 32 patients.

Autor:	Zhang HB; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China., Zhai XL; Department of Neurosurgery, Shuyang Hospital, Xuzhou Medical University, Xuzhou, China., Li L; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China., Wu DS; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China., Zhuang GL; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China., Xu QW; Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China., Guo H; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China., Wang J; Department of Neurosurgery, Shanghai Deji Hospital, Qingdao University, Shanghai, China.
Jazyk:	angličtina
Zdroj:	Annals of translational medicine [Ann Transl Med] 2022 Aug; Vol. 10 (15), pp. 832.
DOI:	10.21037/atm-22-3568
Abstrakt:	Background: Spinal dural arteriovenous fistula (SDAVF) is an extremely rare spinal vascular malformation. As SDAVF exhibits no specific clinical manifestations nor diverse imaging results, it is easily misdiagnosed, resulting in delayed treatment and irreversible neurological damage. Most patients were initially misdiagnosed, but there were few reports on reducing misdiagnosis. Methods: A total of 32 consecutive patients, who presented to our institution (Shanghai Deji Hospital) with SDAVF between June 2013 and January 2016 were retrospectively analyzed. Data were collected on demographics, clinical presentation, imaging findings, follow-up, and clinical outcomes. The Aminoff-Logue scale (ALS) was used to assess clinical outcomes. Results: Of the 32 enrolled patients (3 females, mean age 59.1±3.8 years), 23 patients (71.9%) were misdiagnosed as acute myelitis (11 patients), intramedullary tumors (6 patients), lumbar disc herniation (4 patients), and other conditions (2 patients). All patients underwent surgical procedures under electrophysiological monitoring. Fistulas were found in all 32 patients and were successfully occluded. The mean follow-up period was 19.22±8.21 months (ranging from 2 weeks to 30 months). One year later, 20 patients underwent magnetic resonance imaging (MRI), and 14 showed no T2 edema, and the edema was relieved in 6 patients. A total of 10 patients underwent enhancement MRI and no enhancement signs were detected. Among the 27 patients with long-time follow-up, the fistula had no residual or recurrence, 21 patients showed decreased ALS scores (P<0.05). Six patients exhibited nonsignificant improvement. No aggravating patient was found. Prognosis differed significantly between patients with ALS <6 and those with ALS ≥6 (P<0.05). Conclusions: Spinal angiography should be performed with full intubation, and microcatheter angiography can reduce misdiagnosis. SDAVF must be differentiated from acute myelitis, intramedullary tumor, and other spinal vascular malformations. Microsurgical treatment is effective with a low recurrence rate. Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-3568/coif). The authors have no conflicts of interest to declare. (2022 Annals of Translational Medicine. All rights reserved.)
Databáze:	MEDLINE
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