PT - JOURNAL ARTICLE AU - L. Antonietti AU - S.A. Sheth AU - V.V. Halbach AU - R.T. Higashida AU - C.F. Dowd AU - M.T. Lawton AU - J.D. English AU - S.W. Hetts TI - Long-Term Outcome in the Repair of Spinal Cord Perimedullary Arteriovenous Fistulas AID - 10.3174/ajnr.A2236 DP - 2010 Nov 01 TA - American Journal of Neuroradiology PG - 1824--1830 VI - 31 IP - 10 4099 - http://www.ajnr.org/content/31/10/1824.short 4100 - http://www.ajnr.org/content/31/10/1824.full SO - Am. J. Neuroradiol.2010 Nov 01; 31 AB - BACKGROUND AND PURPOSE: The natural history of PMAVFs, also known as type IV spinal cord AVFs, is incompletely understood. Both open surgical and endovascular approaches have been described as treatment modalities for this disease. The goal of this study was to evaluate the long-term outcome of patients with PMAVFs treated at a single tertiary care institution. MATERIALS AND METHODS: We conducted a retrospective study of 32 patients with PMAVFs, evaluated between 1983 and 2009. Data were gathered by reviewing outpatient clinic notes, operative and radiologic reports, and spinal angiograms. The PMAVFs were categorized into 1 of 3 types based on the angiographic imaging criteria. Pretreatment and posttreatment ambulation and micturition symptoms were quantified by using the ALS. RESULTS: Thirty patients underwent corrective procedures, 4 by embolization alone, 11 by surgery alone, and 15 with a combination of the 2. Twenty-eight patients underwent follow-up spinal angiography, with residual shunt noted in 6 patients. The mean follow-up period was 54 months (range, 1–228 months). Analysis of the ALS scores revealed that treatment of PMAVFs, independent of technique, resulted in significant improvement in ambulation but inconsistent changes in micturition. In addition, residual fistula at the time of the follow-up angiogram was associated with worsened neurologic status or lack of improvement. Outcome analysis based on fistula type showed dramatic improvement in ALS ambulation scores (62%) for type 3 fistulas, compared with types 1 and 2 (26% and 27%, respectively). CONCLUSIONS: Significant improvement in ambulation but in not micturition was observed following treatment. Residual fistula on follow-up angiography was associated with progressive worsening or lack of improvement in neurologic function. Patients with type 3 fistulas were shown to benefit most from treatment, with marked improvement in posttreatment ambulation scores. As endovascular and surgical techniques continue to evolve, further studies are warranted. ALSAminoff-Logue scaleAmbambulationAngioangiographicallyASAanterior spinal arteryAVFarteriovenous fistulaCcervicalAVMarteriovenous malformationCombocombination of surgery and endovascular treatmentDAVFdural arteriovenous fistulaDxdiagnosisEDHepidural hematomaEmboembolizationFUfollow-up posttreatment (postdiagnosis in nontreated patients) in monthsHematohematomyeliaHHThereditary hemorrhagic telangiectasiaintraopintraoperativeLlumbarmacroAVFlarge arteriovenous fistulamicroAVFsmall arteriovenous fistulaMictmicturitionMRIMR imagingmyelomyelopathyNAnot applicableORsurgeryparaparaplegiaPLSAposterolateral spinal arteryPMAVFperimedullary arteriovenous fistulaPostpost-treatmentpostoppostoperativePrepretreatmentPtspatientsRxtreatmentSAHsubarachnoid hemorrhagehemorrhage includes SAH, hematomyelia, epidural hematoma; SCAVMspinal cord arteriovenous malformationsxssymptomsTthoracicTTDxtime to diagnosis in monthsTTRxtime to treatment in months