Spinal Dural Arteriovenous Fistulae with Rapid Functional Deterioration: Clinical and Radiological Features

Abstract

Background: Spinal Dural Arteriovenous Fistulae (SDAVF) cause usually slowly progressive myelopathy. Specific descriptions of SDAVF with rapid functional deterioration are still lacking in the literature and are purpose of this study. Material and Methods: We retrospectively evaluated data of 59 SDAVF patients who were treated in our institution between 2006 and 2016. Based on clinical course, we dichotomized our cohort in two groups; a) patients with rapid functional deterioration within a period of 0-6 months, b) patients with slowly progressive functional deterioration within a period of more than 6 months. Motor disabilities were rated according to the modified Aminoff- Longue disability score (AL-score) as follows: 1) mild: AL-score 0-1, 2) moderate: AL-score 2-3, 3) severe: AL-score 4-5. Alterations of the perimedullar veins were rated subjectively as absent, mild or prominent. Follow-up analysis was performed via telephone survey. Results: Complete data of forty patients was eligible for this analysis. Thirteen and twenty-seven patients were included in group (a) and (b) respectively. The durations of symptom differed significantly between both groups (p=0.02). AL-scores showed no significant differences between both groups at time of diagnosis. However, patients group (a) presented more prominent perimedullar veins at time of diagnosis and better outcome at the last follow-up. Conclusion: Early diagnosis and treatment of SDAVF might decrease the risk of further irreversible damages of the spinal cord and result in a better outcome regardless of the functional condition at time of diagnosis. Further histopathological studies are acquired to improve our understanding of this rare but serious disease.