Long-Term Outcome in the Repair of Spinal Cord Perimedullary Arteriovenous Fistulas
The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated...
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| Veröffentlicht in: | American journal of neuroradiology : AJNR 2010-11, Vol.31 (10), p.1824-1830 |
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| creator | ANTONIETTI, L SHETH, S. A HALBACH, V. V HIGASHIDA, R. T DOWD, C. F LAWTON, M. T ENGLISH, J. D HETTS, S. W |
| description | The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated at a single tertiary care institution.
We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS.
Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1-228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively).
Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted. |
| doi_str_mv | 10.3174/ajnr.a2236 |
| format | Article |
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We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS.
Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1-228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively).
Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted.</description><identifier>ISSN: 0195-6108</identifier><identifier>EISSN: 1936-959X</identifier><identifier>DOI: 10.3174/ajnr.a2236</identifier><identifier>PMID: 20813874</identifier><identifier>CODEN: AAJNDL</identifier><language>eng</language><publisher>Oak Brook, IL: American Society of Neuroradiology</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Angiography ; Arteriovenous Fistula - diagnostic imaging ; Arteriovenous Fistula - surgery ; Arteriovenous Fistula - therapy ; Biological and medical sciences ; Child ; Child, Preschool ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Nervous system ; Postoperative Complications ; Radiodiagnosis. Nmr imagery. Nmr spectrometry ; Retrospective Studies ; Spinal Cord - blood supply ; Spine ; Treatment Outcome ; Vascular Surgical Procedures ; Young Adult</subject><ispartof>American journal of neuroradiology : AJNR, 2010-11, Vol.31 (10), p.1824-1830</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © American Society of Neuroradiology 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c505t-a5b88f485ec7582b64d4f936b12972238e9e670ac8472b92e5f6268f345c06413</citedby><cites>FETCH-LOGICAL-c505t-a5b88f485ec7582b64d4f936b12972238e9e670ac8472b92e5f6268f345c06413</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7964018/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7964018/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23501400$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20813874$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ANTONIETTI, L</creatorcontrib><creatorcontrib>SHETH, S. A</creatorcontrib><creatorcontrib>HALBACH, V. V</creatorcontrib><creatorcontrib>HIGASHIDA, R. T</creatorcontrib><creatorcontrib>DOWD, C. F</creatorcontrib><creatorcontrib>LAWTON, M. T</creatorcontrib><creatorcontrib>ENGLISH, J. D</creatorcontrib><creatorcontrib>HETTS, S. W</creatorcontrib><title>Long-Term Outcome in the Repair of Spinal Cord Perimedullary Arteriovenous Fistulas</title><title>American journal of neuroradiology : AJNR</title><addtitle>AJNR Am J Neuroradiol</addtitle><description>The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated at a single tertiary care institution.
We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS.
Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1-228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively).
Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angiography</subject><subject>Arteriovenous Fistula - diagnostic imaging</subject><subject>Arteriovenous Fistula - surgery</subject><subject>Arteriovenous Fistula - therapy</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Embolization, Therapeutic</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Postoperative Complications</subject><subject>Radiodiagnosis. Nmr imagery. Nmr spectrometry</subject><subject>Retrospective Studies</subject><subject>Spinal Cord - blood supply</subject><subject>Spine</subject><subject>Treatment Outcome</subject><subject>Vascular Surgical Procedures</subject><subject>Young Adult</subject><issn>0195-6108</issn><issn>1936-959X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkV1LHDEYhYNU6tb2xh8guSmFwuibz0luCstSq7CgVAu9C5lsRiOzyTaZEfrvm8WtH1dehZc8HJ7DQeiIwAkjLT-19zGfWEqZ3EMzoplstNC_36EZEC0aSUAdoA-l3AOA0C19jw4oKMJUy2foepnibXPj8xpfTqNLa49DxOOdxz_9xoaMU4-vNyHaAS9SXuErn8Par6ZhsPkvnuex3unBxzQVfBbKOA22fET7vR2K_7R7D9Gvs-83i_NmefnjYjFfNk6AGBsrOqV6roR3rVC0k3zF-2rfEVotKVNee9mCdYq3tNPUi15SqXrGhQPJCTtE3x5zN1NXnZyPY7aD2VTDKmeSDeb1Twx35jY9mFZLDkTVgC-7gJz-TL6MZh2K87Vb9LWQ0YJLAM31m6QCxSXjLa_k10fS5VRK9v2TDwGzncts5zLz7VwVPn7Z4An9v08FPu8AW5wd-myjC-WZYwIIB2D_AH00nfY</recordid><startdate>20101101</startdate><enddate>20101101</enddate><creator>ANTONIETTI, L</creator><creator>SHETH, S. 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Nmr imagery. Nmr spectrometry</topic><topic>Retrospective Studies</topic><topic>Spinal Cord - blood supply</topic><topic>Spine</topic><topic>Treatment Outcome</topic><topic>Vascular Surgical Procedures</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>ANTONIETTI, L</creatorcontrib><creatorcontrib>SHETH, S. A</creatorcontrib><creatorcontrib>HALBACH, V. V</creatorcontrib><creatorcontrib>HIGASHIDA, R. T</creatorcontrib><creatorcontrib>DOWD, C. F</creatorcontrib><creatorcontrib>LAWTON, M. T</creatorcontrib><creatorcontrib>ENGLISH, J. D</creatorcontrib><creatorcontrib>HETTS, S. 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W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Outcome in the Repair of Spinal Cord Perimedullary Arteriovenous Fistulas</atitle><jtitle>American journal of neuroradiology : AJNR</jtitle><addtitle>AJNR Am J Neuroradiol</addtitle><date>2010-11-01</date><risdate>2010</risdate><volume>31</volume><issue>10</issue><spage>1824</spage><epage>1830</epage><pages>1824-1830</pages><issn>0195-6108</issn><eissn>1936-959X</eissn><coden>AAJNDL</coden><abstract>The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated at a single tertiary care institution.
We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS.
Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1-228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively).
Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted.</abstract><cop>Oak Brook, IL</cop><pub>American Society of Neuroradiology</pub><pmid>20813874</pmid><doi>10.3174/ajnr.a2236</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Angiography Arteriovenous Fistula - diagnostic imaging Arteriovenous Fistula - surgery Arteriovenous Fistula - therapy Biological and medical sciences Child Child, Preschool Embolization, Therapeutic Female Follow-Up Studies Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Nervous system Postoperative Complications Radiodiagnosis. Nmr imagery. Nmr spectrometry Retrospective Studies Spinal Cord - blood supply Spine Treatment Outcome Vascular Surgical Procedures Young Adult |
| title | Long-Term Outcome in the Repair of Spinal Cord Perimedullary Arteriovenous Fistulas |
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