Diagnosis Of Spinal Dural Arteriovenous Fistula Research Articles

Potential biomarkers of spinal dural arteriovenous fistula: C4BPA and C1QA

Background and purposeA major challenge in spinal dural arteriovenous fistula (SDAVF) is timely diagnosis, but no specific predictive biomarkers are known.MethodsIn the discovery cohort (case, n = 8 vs. control, n = 8), we used cerebrospinal fluid (CSF) and paired plasma samples to identify differentially expressed proteins by label-free quantitative proteomics. Further bioinformatics enrichment analyses were performed to screen target proteins. Finally, it was validated by ELISA in two of the new cohorts (case, n = 17 vs. control, n = 9), and univariate analysis, simple linear regression, and receiver operator characteristic (ROC) curve analysis were performed to evaluate the diagnostic potential.ResultsIn the discovery cohort, the most overexpressed proteins were APOB and C4BPA in CSF samples of patients. The GO/KEGG enrichment analysis indicated that the upregulated proteins were mainly involved in the acute inflammatory response and complement activation. Hub-gene analysis revealed that APP might be the key protein in the molecular interaction network. In the validation cohort, C4BPA and C1QA were significantly overexpressed in the CSF of patients, averaging 3046.9 ng/ml and 2167.2 ng/ml, respectively. Simple linear regression demonstrated that levels of C1QA and C4 were positively correlated with total protein in CSF (R2 = 0.8021, p = 0.0005; R2 = 0.7447, p = 0.0013). The areas under the ROC curves of C4BPA and C1QA were 0.86 and 1.00, respectively.ConclusionsThis study was the first to identify C4BPA and C1QA as potential biomarkers for the diagnosis of SDAVF and revealed that complement pathway activation might be one of the molecular mechanisms for venous hypertension myelopathy.

Feasibility of Noninvasive Diagnosis of Spinal Vascular Diseases Using Time-Resolved Angiography With Stochastic Trajectories.

Background and Purpose: To determine the feasibility of time-resolved angiography with stochastic trajectories (TWIST) in the diagnosis of spinal dural arteriovenous fistula (SDAVF) and perimedullary arteriovenous fistula (PAVF).Methods: A total of 11 negative patients with TWIST examination were retrospective analyzed and then 18 patients with suspected spinal vascular diseases underwent TWIST. For negative patients, Adamkiewicz artery (AKA), great anterior radiculomedullary vein (GARV) and anterior spinal artery (ASA) were retrospective analyzed. In patients, the results of TWIST were compared with those of DSA.Results: The displaying rates of the ASA, AKA and GARV in 11 negative patients were 100, 90.9, and 90.9%, respectively. The AKA and GARV were separated on TWIST. Of 18 patients, 11 and three were diagnosed with SDAVF and PAVF, respectively. The spinal cord vascular malformation diagnosed on TWIST was consistent with DSA with an excellent intermodality agreement (Kappa = 0.92, p < 0.001). The feeding artery and side of all 11 SDAVF patients were displayed on TWIST and the results were consistent with DSA. For PAVF patients, the feeding artery in two patients and the sides as displayed on TWIST were consistent with DSA.Conclusions: TWIST enables the differentiation of the spinal artery and vein and the differential diagnosis of SDAVF and PAVF.

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

Combined Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas

IntroductionType I spinal dural arteriovenous fistulas (SDAVFs) are the most common form of spinal vascular malformations. Even so, they are rare and still underdiagnosed. They are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Left untreated, they can lead to progressive neurological decline and considerate morbidity. We present our experiences and results in combined endovascular and surgical treatment of such lesions. Material and MethodsWe conducted a retrospective review of data from 14 adult patients with the diagnosis of SDAVFs who underwent treatment at University Hospital Center Rebro Zagreb between January 2012 and June 2014. We compared complication rates, recurrence rates and data on clinical and imaging follow up in these patients. Results12 out of 14 patients underwent endovascular embolization (Onyx was used in 1 patients and NBCA in 11 patients) as the first line therapy. Two patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status after treatment (using the Aminoff-Logue Scale score). One patient in endovascular group developed spinal infarction due to accidental embolization of posterior spinal artery. Six patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group had recurrence of fistula during the course of follow- up and were reoperated. ConclusionDespite most fistulas are amenable to endovascular embolization, microsurgical obliteration is the treatment of choice in specific anatomic situations and usually the only solution in recurrent cases. A combined approach offers the best results after careful selection of patients based on imaging.

Combined Endovascular and Surgical Treatment of Type I Spinal Dural Arteriovenous Fistulas

Introduction Spinal dural arteriovenous fistulas (SDAVFs) are rare but most common form of spinal vascular malformations, accounting for approximately 70% of all such lesions. They are low-flow vascular shunts fed by radicular arteries. Patients most often present with myelopathy. The presumed pathophysiological mechanism is venous hypertension and congestion of the cord with edema. We present our experiences and results in combined endovascular and surgical treatment of type I SDAVFs. Patients and Methods We conducted a retrospective review of prospectively collected data from patients with a diagnosis of SDAVFs who underwent treatment at University Hospital Centre Rebro Zagreb between January 2012 and June 2014. The complication and recurrence rates from clinical and imaging follow-up in these patients are analyzed. Results A total of 14 patients with a diagnosis of SDAVFs were treated in our institution during the analyzed period. Of these, 12 patients underwent endovascular embolization as first-line therapy. Onyx was used in 1 patient and NBCA in 11 patients. Two patients underwent surgical ligation as the initial therapeutic procedure. Patients in both groups showed significant improvement in clinical status after treatment on the Aminoff-Logue Scale. One patient in the endovascular group developed spinal infarction because of the accidental embolization of posterior spinal artery. Six patients in embolization group had recurrence of the fistula during the course of follow-up requiring surgical ligation. Two patients in the surgical group had recurrence of fistula during the course of follow-up and were reoperated. Conclusion Although most type I SDAFs are amenable to endovascular embolization, microsurgical obliteration as first option is indicated in specific anatomic situations and usually the only solution for recurrent cases. The combined endovascular and microsurgical approach offers best results after careful selection of patients based on imaging.

Spinal Dural Arteriovenous Fistula: Imaging Features and Its Mimics.

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation, however it is still rare and underdiagnosed. Magnetic resonance imaging findings such as spinal cord edema and dilated and tortuous perimedullary veins play a pivotal role in the confirmation of the diagnosis. However, spinal angiography remains the gold standard in the diagnosis of SDAVF. Classic angiographic findings of SDAVF are early filling of radicular veins, delayed venous return, and an extensive network of dilated perimedullary venous plexus. A series of angiograms of SDAVF at different locations along the spinal column, and mimics of serpentine perimedullary venous plexus on MR images, are demonstrated. Thorough knowledge of SDAVF aids correct diagnosis and prevents irreversible complications.

Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients

Background:Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited.Methods:We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff–Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients.Results:Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up.Conclusions:Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.

Successful presurgical management by intravenous steroid therapy in spinal dural arteriovenous fistula

AbstractThe present report describes the case of a 57‐year‐old male patient with spinal dural arteriovenous fistula (AVF). During the diagnostic examination, intravenous steroid therapy was implemented. The next day, the patient's symptoms were mildly improved and magnetic resonance imaging showed that the spinal cord swelling was markedly reduced. After the angiographic diagnosis of spinal dural AVF fed from the radicular artery originating from the sixth intercostal artery, the shunts were surgically interrupted by cutting the drainage vein. Clinical deterioration after steroid therapy was reported in several previous papers on this disorder. Based on the present case, however, we propose the possibility that intravenous steroid therapy is a viable option for presurgical management.

Therapeutic Clues In Spinal Dural Arteriovenous Fistulas – A 30 Year Experience Of 156 Cases

Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach. From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique. 156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means. Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.

Management of Spinal Dural Arteriovenous Fistulae with Emphasis on an Endovascular Approach

Spinal arteriovenous shunts are rare and present at a rate of approximately 1:10 with cerebral arteriovenous shunts. Spinal dural arteriovenous fistulas (SDAVF) are the most common type of spinal vascular malformation in the adult and account for about 60% of all, with a marked male predominance (5:1). Endovascular treatment has gained force as the treatment of choice in recent years. We reviewed the patients sent to our service at Clinica del Rosario in Madrid and Hospital General de Cataluña in Barcelona between January 1991 and December 2005 with a diagnosis of SDAVF made clinically or by imaging for possible endovascular treatment. Location, presenting symptoms, and clinical outcome according to treatment were analyzed. A total of 104 patients were diagnosed and treated for a SDAVF, 85 were men and 19 women aged between 23 and 79 years (average 58). Seventy-six were treated with embolization alone (73%), 21 with a combination of endovascular therapy and surgery (20.1%) and seven patients had surgery alone (6.7%). Of the embolization group, 62 patients were cured (81.5%), 11 improved (14.4%) and three (3.9%) worsened. Of the group with combined therapy, 13 (61.9%) were cured, five (23.8%) improved and three (14.2%) worsened. Among the surgery group, four (57.2%) were cured and three (42.8%) worsened. Endovascular approach with liquid adhesive is gaining more acceptance as the treatment of choice for SDAVF if the conditions allow a super selective catheterization of the shunt. These patients benefit most when diagnosis is made early in the course of the pathology and have a better chance of a complete remission of symptoms.