gms | German Medical Science

Objective: Spinal dural arterio-venous fistulas (SDAVF) are rare vascular pathologies. The degree of symptom improvement after surgical treatment remains unclear. We evaluated surgically treated SDAVF patients for symptom improvement.

Methods: Retrospective inclusion of all patients treated surgically in our department for SDAVF consecutively between 2007 and 2019. We measured functional outcome using the McCormick Scale.

Results: We included a total of 27 patients. Mean age was 61.8years (standard deviation 8.4), 40.7% were female. The most frequent location was the thoracic spine in 15 (55.6%) followed by lumbar in 8 (29.6%), cervical in 3 (11.1%) and sacral spine in one patient (3.7%). The most common presenting symptom was progressive myelopathy in 24/27 patients (88.9%). Two patients (7.4%, both with foramen magnum SDAVF) presented with acute haemorrhage. Only in one patient was the SDAVF an incidental finding. In three patients (11.1%) SDAVF were embolised before surgery. In all patients the SDAVF was completely resected, however in 4 patients (14.8%) complete surgical resection required a second surgical interventions. Four patients (14.8%) deteriorated initially after surgery. On discharge, presenting symptoms had improved in 17 patients (63%), 9/27 patients (33.3%) had a McCormick score of 1. Follow-up was available in 19 patients (67.4%) with a median of 10.3 months (IQR 42.5, minimum 1.2, maximum 252). Seventeen patients (89.5%) continued to improve on follow-up. In total 22/27 patients (81.5%) improved.

Conclusion: Untreated SDAVF lead to progressive myelopathy which may result in considerable disability. Surgical disconnection and resection of the SDAVF provides a safe treatment option with relatively low perioperative morbidity and good chances for improvement or at least myelopathy progression prevention.