Victor Gabriel El-Hajj, Cornelia Daller, Alexander Fletcher-Sandersjöö, Maria Gharios, Mohamad Bydon, Michael Söderman, Pascal Jabbour, Erik Edström, Adrian Elmi-Terander, Fabian Arnberg
{"title":"治疗延误对脊髓硬膜动静脉瘘长期神经功能预后的负面影响：一项纵向队列研究","authors":"Victor Gabriel El-Hajj, Cornelia Daller, Alexander Fletcher-Sandersjöö, Maria Gharios, Mohamad Bydon, Michael Söderman, Pascal Jabbour, Erik Edström, Adrian Elmi-Terander, Fabian Arnberg","doi":"10.3171/2023.12.focus23703","DOIUrl":null,"url":null,"abstract":"OBJECTIVE\n<p>Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs.</p>\nMETHODS\n<p>In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study.</p>\nRESULTS\n<p>Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03–1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18–12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00–1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0–306.7, p < 0.001).</p>\nCONCLUSIONS\n<p>Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.</p>","PeriodicalId":19187,"journal":{"name":"Neurosurgical focus","volume":null,"pages":null},"PeriodicalIF":3.3000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study\",\"authors\":\"Victor Gabriel El-Hajj, Cornelia Daller, Alexander Fletcher-Sandersjöö, Maria Gharios, Mohamad Bydon, Michael Söderman, Pascal Jabbour, Erik Edström, Adrian Elmi-Terander, Fabian Arnberg\",\"doi\":\"10.3171/2023.12.focus23703\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVE\\n<p>Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs.</p>\\nMETHODS\\n<p>In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study.</p>\\nRESULTS\\n<p>Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03–1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18–12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00–1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0–306.7, p < 0.001).</p>\\nCONCLUSIONS\\n<p>Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.</p>\",\"PeriodicalId\":19187,\"journal\":{\"name\":\"Neurosurgical focus\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.3000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Neurosurgical focus\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3171/2023.12.focus23703\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurosurgical focus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2023.12.focus23703","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：硬脑膜动静脉瘘是一种影响大脑和脊髓的罕见血管畸形。脊髓硬膜动静脉瘘（sdAVFs）是最常见的脊髓血管畸形。本研究的目的是评估治疗延迟对开放手术或介入治疗 sdAVFs 的长期神经功能预后的影响。方法在这项基于人群的回顾性队列研究中，作者对 2005 年至 2020 年间在一家三级医疗中心确诊的连续 sdAVFs 患者进行了检查。在不同的时间点，包括症状发作、初级保健就诊、首次专科门诊就诊以及短期和长期随访时，作者使用Aminoff-Logue残疾量表（ALS）对患者进行了评估。术后长期ALS步态和膀胱等级是研究的主要结果。结果在纳入研究的34名患者中，中位年龄为65岁，男性占多数（71%）。大多数病变位于腰部（47%）。术前观察到 ALS 步态和膀胱分级明显恶化，术后有所改善（p <0.05）。手术治疗和血管内治疗的结果没有差异。年龄较大（OR 1.10，95% CI 1.03-1.17，p = 0.007）、术前 ALS 步态分级较差（OR 5.12，95% CI 2.18-12.4，p <0.001）以及从首次专科门诊到首次治疗的时间较长（OR 1.00，95% CI 1.00-1.01，p = 0.040）与较差的长期步态预后独立相关。只有术前ALS膀胱评分是长期膀胱功能较差的预测因素（OR 92.7，95% CI 28.0-306.7，p <0.001）。结论sdAVFs的手术治疗和血管内治疗都能显著改善神经功能。结论手术治疗和血管内治疗都能明显改善 sdAVFs 的神经功能，但治疗延迟与较差的长期预后有关。在症状进展之前及时诊断和早期干预可促进康复并有助于保护神经功能。
The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study
OBJECTIVE
Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs.
METHODS
In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study.
RESULTS
Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03–1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18–12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00–1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0–306.7, p < 0.001).
CONCLUSIONS
Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
