Retrospective Analysis Of Surgical Methods And Prognosis In 41 Patients With Spinal Dural Arteriovenous Fistula

Objective:To explore the application value of intraoperative fluorescein angiography(IFA)or intraoperative angiography(IOG)in the operation of spinal dural arteriovenous fistula(SDAVF).To compare the therapeutic effect and recurrence rate of microsurgery and endovascular embolization,and to explore the diagnosis,treatment,prognosis and related factors of SDAVF.Method:A total of 41 patients with SDAVF were enrolled in this study.From January 2012 to January 2018,neurosurgery department of West China Hospital of Sichuan University treated 28 patients with microsurgery,intraoperative indoeyanine green(ICG)angiography or compound operating room angiography,and interventional embolization in 13 patients.The spinal cord function was assessed by modified Aminoff-Logue scoring system.The follow-up period ranged from 6 months to 72 months(average 26 months).To compare the efficacy and recurrence rate of microsurgery and endovascular embolization.The prognostic factors of spinal cord DAVF patients were analyzed statistically(including gender,age,time interval between onset and definite operation,hormone use before operation,fistula location,degree of preoperative spinal cord nerve function injury,anticoagulation treatment after operation,treatment methods,etc.).Result:In the 28 cases treated with microsurgery,fistula was located in cervical segment in 2 cases;upper thoracic segment(T1-8)in 8 cases;lower thoracic segment(T9-12)in 10 cases;and lumbar segment in 8 cases.The fistula was successfully found and excised in all patients.After operation,18 patients were cured,8 improved and 2 unchanged.The improvement rate was 92.85%.The improved ALS score was 2.1 +1.4,which was significantly better than that before operation(P< 0.05).In the endovascular embolization group,13 cases had fistula in the neck,3 cases in the upper thoracic(T1-8),3 cases in the lower thoracic(T9-12)and 6 cases in the lumbar region.7 cases were cured after follow-up.There were 4 cases improved and 2 cases unchanged.However,there were 2 cases of recurrence after operation,and no further review was made after re-embolization.The improvement rate was 84.6%,and the improved ALS score was 2.2 + 1.5,which was significantly better than that before operation(P< 0.05).Microsurgery is an effective method for the treatment of dural arteriovenous fistula.Intraoperative indocyanine green fluorescence angiography can effectively improve the accuracy of surgery and the effect of surgery.There was no significant difference between surgical treatment and interventional embolization of SDAVF(P=0.412).The recurrence rate of microsurgery group(0.0%)was significantly lower than that of endovascular embolization,but there was no significant difference(P=0.303).Univariate analysis showed that the onset of SDAVF was correlated with the time interval between definite operation,hormone use before operation and the severity of spinal cord nerve function injury,and the prognosis of SDAVF.Multivariate logistic regression analysis showed that the onset of SDAVF was related to the time interval between definite operation,the use of hormones before operation and the degree of spinal nerve function injury.Conclusion: 1.The onset of SDAVF is nonspecific and concealed.It is very easy to be misdiagnosed as other diseases.With the development of the course of disease,clinical manifestations and signs are gradually aggravated.But a few can present acute manifestations.According to the suspicious clinical manifestations,combined with imaging examination,the diagnosis should be made as soon as possible.Multidisciplinary doctors should work together to develop individualized and refined diagnosis and treatment programs.Improve the quality of life of patients to the greatest extent.2.Microsurgery is an effective method for the treatment of dural arteriovenous fistula.The application of intraoperative angiography can effectively improve the accuracy of surgery and the effect of surgery.3.There was no significant difference between the two treatment methods of SDAVF(P=0.412).Although the recurrence rate of fistula in the interventional group(15.3%)was higher than that in the surgical group(0.0%).But there was no statistical significance in the comparative analysis(P=0.303).4.The interval between onset and definite operation,the use of hormones before operation and the degree of spinal nerve function injury are independent risk factors affecting the prognosis of SDAVF patients.