The clinical value of venous drainage in patients with spinal dural arteriovenous fistula

Background: Spinal dural arteriovenous fistulas (sdAVF) with rapid deterioration are a known clinical phenomenon but have been rarely reported in the past. Clinical and radiologic features of these fistulas are analyzed for this study.

Material and methods: We retrospectively reviewed our medical records for sdAVF patients who were treated in our center between 2006 and 2017. Our cohort was dichotomized in two groups; a) patients with acute/ subacute onset and rapid deterioration within a period of ≤6 months, b) patients with chronic progressive deterioration within a period of >6 months. MR findings at time of diagnosis were re-evaluated. All patients were treated microsurgically. Follow-up data were included.

Results: Data of forty patients were available for this study. Rapid deterioration was observed in 13/40 (32.5%) patients. AL-score at time of diagnosis did not differ between both groups (3.2 ± 1.2 vs 3 ± 2, p = .78). Patients with rapid deterioration showed significantly more prominent arterialized perimedullay veins at time of diagnosis (p < .05). At the last follow-up (53 ± 3 months), patients with rapid deterioration improved up to one point on AL-scores (from 3.2 ± 1.4 to 2 ± 1.6) and those with chronic progressive deterioration were unchanged (from 3 ± 1.6 to 3 ± 1.7).

Conclusion: Patients with rapid deterioration in our group (32.5%) presented with a significantly more prominent appearance of the arterialized perimeduallry veins. This may reflect, in the earlier phase of the disease, a better compensation of the venous hypertension as well as the associated venous outlet disorder of the spinal cord. This may also explain the better outcome of these patients.