Treatment for Spinal Cord Arteriovenous Shunts: The Efficacy and Deficiency of Contemporary Clinical Interventions

Abstract

Background: Contemporary treatments for spinal cord arteriovenous shunt (SCAVS) are only based on clinicians’ treatment experiences and expertise due to its rarity. We reviewed the clinical course of the largest multi-cantered SCAVS cohort for efficacy and deficiency of contemporary interventional treatments for SCAVSs. Methods: The clinical features, treatment results and clinical outcomes of 459 SCAVSs patients were retrospectively assessed. Partial obliteration of SCAVS was defined as shunt-reduction obliteration (the nidus or shunt points was reduced) or palliative obliteration (only obliterated aneurysms or feeders). Neurological deterioration occurred 2 weeks after treatment was defined as long-term deterioration and further classified as acute and gradual. Findings: Cure rate was 40·3% for whole cohort, 58·5% after microsurgery, and 25·6% after embolization. Non-metameric lesions, lesions with a maximum diameter < 3 cm and lesions without anterior sulcal artery supply were independent predictors for complete resection. Fistula-type lesions and main drainage diameter < 1·5 mm were independent predictors for complete embolization. Permanent treatment-related neurological deficits rate was 11·3% for the whole cohort, 16·1% after microsurgery, and 5·6% after embolization. The pre-treatment clinical deterioration rate was 32·4%/year, which decreased to 9·2%/year after clinical interventions. After partial treatment, the long-term acute and gradual deterioration rate were 5·3%/year and 3·6%/year, respectively. The acute deteriorations were associated with metameric lesions, craniocervical lesions, lesions with a maximum diameter ≥2 cm and residual aneurysms. The gradual deteriorations were associated with palliative obliteration, absence of pre-treatment acute deterioration and intact main drainage. Interpretation: Although clinical risks of SCAVSs were reduced after clinical interventions, contemporary treatments of SCAVS remains associated with considerable risks and incomplete efficacy. Individualized treatment plans should be adopted according to the angioarchitectural features and major clinical risks of specific lesions. Contemporary treatment is ineffective in reducing hemorrhagic risk of incurable spinal metameric arteriovenous shunts. Funding Statement: None. Declaration of Interests: None. Ethics Approval Statement: The study was reviewed and approved by the local ethics committee with waiver of informed consent from patients given its retrospective nature.