Spinal Dural Arteriovenous Fistula: Diagnosis, Outcomes, and Prognostic Factors

World Neurosurg. 2020 Dec:144:e306-e315. doi: 10.1016/j.wneu.2020.08.126. Epub 2020 Aug 25.

Abstract

Objective: Typically, the clinical presentation of a spinal dural arteriovenous fistula (SDAVF) will be insidious, with patients' symptoms regularly attributed to other conditions. Although previous studies have characterized the neurologic outcomes after treatment for SDAVFs, little is known about the pretreatment patient characteristics associated with poor and/or positive patient outcomes. We sought to characterize the pretreatment patient demographics, diagnostic history, and neurologic outcomes of patients treated for SDAVFs and to identify the patient factors predictive of these outcomes.

Methods: The medical records of patients who had been treated for SDAVFs from 2006 to 2018 across 1 healthcare system were retrospectively analyzed. Neurologic status was assessed both before and after intervention using the Aminoff-Logue scales for gait and micturition disturbances.

Results: Of 46 total patients, 16 (35%) had a documented misdiagnosis. Patients with a history of misdiagnosis had had a significantly longer symptom duration before treatment compared with those without a misdiagnosis (median, 2.3 vs. 0.9 years; P = 0.018). A shorter symptom duration before intervention was significantly associated with both improved motor function (median, 0.8 vs. 3.1 years; P = 0.001) and improved urinary function (median, 0.8 vs. 2.2 years; P = 0.040) after intervention.

Conclusions: Misdiagnosis has been relatively common in patients with SDAVFs and contributes to delays in treatment. Delays in diagnosis and treatment of SDAVFs appear to be associated with worse clinical outcomes for patients who, ultimately, receive treatment.

Keywords: Arteriovenous malformation; Prognosis; SDAVF; Spinal dural arteriovenous fistula; Spine; Type I spinal arteriovenous malformation.

MeSH terms

  • Aged
  • Central Nervous System Vascular Malformations / diagnosis*
  • Central Nervous System Vascular Malformations / surgery*
  • Diagnostic Errors / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Recovery of Function
  • Retrospective Studies
  • Spinal Cord Diseases / diagnosis*
  • Spinal Cord Diseases / surgery*
  • Time-to-Treatment / statistics & numerical data