TY - JOUR
T1 - Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas
T2 - An overview
AU - Fugate, Jennifer E.
AU - Lanzino, Giuseppe
AU - Rabinstein, Alejandro A.
PY - 2012/5
Y1 - 2012/5
N2 - Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.
AB - Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.
KW - Central nervous system vascular malformation
KW - Dural arteriovenous fistula
KW - Spinal cord disease
KW - Spinal cord ischemia
UR - http://www.scopus.com/inward/record.url?scp=84861783860&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84861783860&partnerID=8YFLogxK
U2 - 10.3171/2012.1.FOCUS11376
DO - 10.3171/2012.1.FOCUS11376
M3 - Review article
C2 - 22537126
AN - SCOPUS:84861783860
SN - 1092-0684
VL - 32
JO - Neurosurgical focus
JF - Neurosurgical focus
IS - 5
M1 - E17
ER -