| Objective:Analysis of factors related to the prognosis of patients with dural arteriovenous fistulas.Methods:The epidemiological characteristics,imaging data,treatment and follow-up of 41 patients with SDAVFs treated in China Medical University NO.1 hospital during the 2012.1-2017.12 were retrospectively analyzed.Using the China medical university score of the spinal cord angiopathy(including:gait disturbance,sensory symptoms,bowel/bladder disturbances)to quantify function,analyze the clinical significance of surgical prognosis score for spinal dural arteriovenous fistulas of China Medical University.Result:A total of 41 cases were enrolled,including 34 male patients,7 female patients,30 cases were treated by surgery,11 cases were not,aged between 26-82years old,mean age 53.63±15.09 years,duration of 2 days-72 months,the average duration of 13.26±17.79 months.Gait disturbance,sensory symptoms and bowel/bladder disturbances existed in all patients,MRI showed spinal cord abnormal signal(flow void,spinal cord high signal,vascular enhancement and spinal cord swelling),in this set of data,the presence of high signal in the spinal cord of patients accounted for 65.85%,while the tortuous flow void blood vessels accounted for 100%,when existing typical clinical manifestations of SDAVF,then CTA or MRA checked,final spinal angiography remains the gold standard for the diagnosis.Microsurgical treatment was performed in 27 cases(no recurrence),3 cases were treated by interventional embolization(1 case recurred in 9 months),and 11 cases were treated with conservative treatment.After 6-12 months follow-up,the patients were evaluated with the modified Aminoff-Logue score.Operation group:almost all patients had some degrees of functional improvement,of which 56.7%patients got obvious function improvement,40%patients with a slightly better or not worse change,3.3%patients with SDAVFs recurrent.Conservative treatment group:63.6%patients(duration 6-71 months)got worse gradually,until totally lost the movement,sensation and bowel/bladder function,36.4%patients(duration 7-62 months)in stable condition.The SPSS analysis showed that the duration of disease and the prognosis of patients were logarithmic relationship(R~2=0.341 P=0.001).The age and the prognosis were linear relationship(R~2=0.197 P=0.014).The results showed that the surgical treatment can significantly improve the function of patients with SDAVFs compared with the conservative treatment(P=0.000<0.05).The patient operated within the duration of11.63 months,whose function was improved significantly(P=0.000<0.05).Surgical intervention for SDAVFs patients under 60.13 years old could achieve obvious improvement in function(P=0.008<0.05).There was no statistical difference between preoperative score high(be equal or greater than 7)and preoperative score low(less than 7)of the patients in postoperative improvement(P=0.346).Compared with patients with short segment(less than 7 vertebrae),the patients with reflux venous longer than 7 vertebrae was significantly improved(P=0.004<0.05).There was no statistically significant correlation between the prognosis of the SDAVFs patients and the sex and the edema of the spinal cord.Conclusion:Make clear the importance of early diagnosis and early treatment.Surgical or interventional treatment is important for improving the prognosis ofpatients,conservative treatment cannot be improved.There was a statisticallysignificant correlation between surgical or interventional treatment,duration of the disease,patient's age,preoperative state,segment of reflux venous and SDAVFs prognosis.There was no statistically significant correlation between the prognosis of the SDAVFs patients and the sex and the edema of the spinal cord.The prognosisgrading table of dural arteriovenous fistulas of China Medical University can be used to guide clinical treatment,predict the disease and choose a more suitable treatment plan. |
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