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Spinal Dural Arteriovenous Fistulas: A Retrospective Analysis of Prognostic Factors and Long-Term Clinical Outcomes in the Light of the Recent Diagnostic and Technical Refinements

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The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

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Abstract

Spinal dural arteriovenous fistulas (dAVFs) are abnormal connections between the meningeal branches of segmental arteries and a radiculomedullary veins that result in a progressive myelopathy thanks to perimedullary coronal venous plexus congestion. Usually, dAVFs show nonspecific symptoms, thus leading to late clinical suspicion and a difficult MRI diagnosis.

Several authors have tried to identify prognostic factors before treatment, but published studies results are often inconsistent and sometimes contradictory.

In this study, we reviewed our recent experience of 30 dAVF patients where we collected all demographic, clinical and angioarchitectural features as well as radiological and treatment-related characteristics. The thoracic spine was the most common location, constituting 53.3% of cases, followed by the lumbar roots, comprising 30%. About 83% of patients showed motor deficits, urinary disturbances were present in 70%, and bowel symptoms in 50%.

We treated 86.7% of patients with microsurgery and 13.3% with endovascular occlusion with a mean interval between clinical onset and intervention of 10.8 ± 14.2 months.

A significant clinical improvement was observed at follow-up in 80% of patients, with a significant reduction in mean G-score, U-score and F-score at a mean follow-up of 105.89 ± 191.9 months.

However, none among the principal demographic, clinical and radiological characteristics showed significant prognostic value to the clinical improvement observed at follow-up.

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Abbreviations

dAVFs:

Spinal dural arteriovenous fistulas

DSA:

Digital subtraction angiography

mALS:

Modified Aminoff–Logue Disability Scale

MRI:

Magnetic resonance imaging

SEPs:

Somatosensorial evoked potentials

TIVA:

total intravenous anaesthesia

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Authors and Affiliations

  1. Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Carmelo Lucio Sturiale, Anna Maria Auricchio & Alessio Albanese

  2. Department of Radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

    Iacopo Valente & Alessandro Pedicelli

  3. Neurosurgical Clinic, AOUP Paolo Giaccone, Department of Biomedicine Neurosciences and Advanced Diagnostics, School of Medicine, University of Palermo, Palermo, Italy

    Rosario Maugeri

  4. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

Authors
  1. Carmelo Lucio Sturiale
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  2. Anna Maria Auricchio
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  3. Iacopo Valente
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  4. Rosario Maugeri
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  5. Alessandro Pedicelli
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  6. Massimiliano Visocchi
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  7. Alessio Albanese
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Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

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Not applicable.

Conflicts of Interest/Competing Interests

The authors declare no conflicts if interest.

Ethics Approval

IRB approval was not required for the retrospective collection of anonymous data.

Consent to Participate

Informed consent was provided by every patient participating in this study.

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Not applicable.

Author Contributions

Conception and design, CLS; data collection, CLS, AAu, IV, and AP; data analysis, CLS, AAu, and RM; drafting, CLS; helping with drafting, AAu, RM, and AA; approval of final version, CLS and AA.

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Sturiale, C.L. et al. (2023). Spinal Dural Arteriovenous Fistulas: A Retrospective Analysis of Prognostic Factors and Long-Term Clinical Outcomes in the Light of the Recent Diagnostic and Technical Refinements. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_35

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  • DOI: https://doi.org/10.1007/978-3-031-36084-8_35

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36083-1

  • Online ISBN: 978-3-031-36084-8

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