Treatments And Diagnostics For Spinal Dural Arteriovenous Fistula:A Single Center Experience Of 32 Patients

ObjectiveSpinal dural arteriovenous fistula(SDAVF)is one of the most common spinal vascular malformations.Due to the lack of specific clinical manifestations and the diversity of imaging changes,SDAVF is easily misdiagnosed,resulting in delayed treatment and irreversible spinal cord neurological damage.The purpose of this study was to draw lessons from the misdiagnosis cases through retrospective analyze of clinical data,and to improve the technical level of DSA examination.By enhancing the understanding of the imaging signs of the disease,we can therefore improve the methods of microsurgery and intraoperative electrophysiological monitoring.At the same time,it is necessary to explore the prognostic factors of surgical treatment,so as to reduce the occurrence of missed diagnosis and misdiagnosis and finally improve the effectiveness of treatment.MethodsHere,we retrospectively analyzed 32 consecutive patients who received resection in our hospital June,2013-January,2016.The retrospective study included 32 patients,3 females and 29 males,patients with a mean age of 59.1 years ±3.8.32 patients were followed 2 weeks-30 months after surgery,the mean follow-up is 19.22 months ± 8.21.MRI,MRA and DSA were performed before and after operation.Microsurgical treatment was performed with SEP,MEP and EMG monitoring.We utilized the Aminoff-Logue Scale to assess the patients’ status and clinical outcome.Data analyses were carried out by the utilization of IBM SPSS(version 19;IBM Corp.,Armonk,New York,USA),to statistically analyze the effect of treatment with the results of preoperative and postoperative ALS score,neurological function and the location of fistula.ResultsIn the course of diagnosis and treatment,23 cases were misdiagnosed as acute spinal cord inflammation,intramedullary tumors and so on.The fistula was detected in 32 cases and was successfully occluded by electrocoagulation occlusion.After 1 year of surgery,spinal MRI of 20 cases were interviewed,showing that T2 edema disappeared in 14 cases,and edema were relieved obviously in 6 cases,no blood vessel flow was seen,and no enhancement signs were found in 10 patients with spinal cord enhancement MRI.According to the review of DSA in 8 cases,there were no residual and recurrent fistula.In 27 cases of clinical follow-up,21 cases had improved ALS score(P<0.05)with different degree,the improvement was not obvious in 6 cases with no aggravating cases.Improvement of prognosis in ALS<6 group and ALS>6 group were statistically significant(P<0.05).ConclusionThe misdiagnosis rate of SDAVF is higher,and the diagnosis of spinal cord DSA should be fully intubated,and the application of micro-catheter angiography can reduce or avoid missed diagnosis and misdiagnosis.When diagnosing SDAVF,it is necessary to differentiate with acute spinal cord inflammation,spinal intramedullary tumor,SAVM,PMAVF and V-type DAVF.Microsurgical treatment of SDAVF has good effect and low recurrence rate.The application of electrophysiological monitoring in microsurgery can prompt the operation of the spinal cord and reduce unnecessary spinal cord injury.