Diagnosis and treatment of spinal dural arteriovenous fistula: A report of 14 cases

Objective To analyze the diagnosis and treatment of spinal dural arteriovenous fistula (SDAVF). Methods The clinical data of 14 patients with SDAVF admitted to Department of Neurosurgery, General Hospital of the Eastern Theater Command from May 2008 to May 2018 were analyzed retrospectively. All patients underwent the examinations of preoperative spinal cord MRI and spinal cord angiography to identify the region of SDAVF and the location of fistula. Microsurgical resection of SDAVF was conducted via semi-lamina approach. The modified Aminoff-Logue score was used to evaluate the spinal function before operation, after operation and during the follow-up period. Results No abnormal fistulas or tortuous dilated drainage veins were detected by spinal cord angiography after operation in 14 patients. The modified Aminoff-Logue score [median (upper and lower quartiles)] before operation and post operation in those 14 patients were as follows: gait: 2.0 (1.0, 3.0) points vs. 2.0 (1.0, 2.0) points, urinate: 2.0 (0, 2.0) points vs. 1.0 (0, 2.0) points, defecate: 1.0 (0, 2.0) points vs. 0.5 (0, 1.0) points. The postoperative scores were improved compared to preoperative scores (all P<0.05). Of those 14 patients, 6 were lost to follow-up and 8 were followed up for 7.5 (4.5, 12.0) months. The gait, urinate and defecate scores were 0.5 (0, 1.0), 0 (0, 0.7) and 0 (0, 0.5) respectively, which have improved compared with those before operation (all P<0.05). No recurrence of the lesion was found in 8 patients during the last follow-up. Conclusions Spinal cord angiography is the gold standard for the diagnosis of SDAVF. Microsurgery via semi-lamina approach is an effective method for the treatment of SDAVF. The spinal cord function of patients can be improved significantly. Key words: Arteriovenous fistula; Spinal dura; Microsurgery; Clinical characteristics; Spinal cord function