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Results
Background characteristics of 15 patients with Type I SDAVFs are provided in Table 3. Patients' mean age was 60 years (range 40–71 years); 11 patients were male (male/female ratio 2.8:1). Presentation included weakness in 87% of the patients, numbness in 80%, paresthesias in 60%, and bowel/bladder symptoms in 47%. At least 27% of the patients had a history of neck or back trauma and 20% had undergone prior spinal decompressive surgery for spondylotic disease. In all cases, spinal decompression was performed remote to the fistula site for presumed symptomatic lumbar stenosis, without alleviation of symptoms. Notably, MRI revealed that all but 1 patient had spinal cord T2 signal abnormality and abnormal, serpiginous dilated intradural flow voids. The exception was a patient with cervical pain and progressively more prominent intradural flow voids seen on MRI (see Illustrative Case).
Eleven patients underwent surgical treatment of their SDAVF and had at least 1 month of follow-up (Table 3 and Table 4) In 1 of these patients (see Illustrative Case), endovascular therapy had failed prior to surgery. Of the 4 remaining patients, 3 were treated at another center and 1 was treated with embolization. Baseline characteristics of the patients who underwent surgery at our center were similar to those of the entire cohort. Preoperative Aminoff-Logue scores were as follows: a score of 0 was documented in 1 case (9%), a score of 1 in 1 case (9%), a score of 2 in 0 cases, a score of 3 in 7 cases (64%), a score of 4 in 2 cases (18%), and a score of 5 in 0 cases. The anatomical location of the fistulas within the spine for the surgically treated patients were: cervical in 1 patient (9%), thoracic in 6 (55%), lumbar in 3 (27%), and sacral in 1 (9%). The clinical results after surgery, with a mean follow-up duration of 4.7 months (range 1–15 months), are detailed in Table 4. Symptoms improved in 10 (91%) of 11 patients, stayed the same in 1 (9%), and worsened in 0 patients. Specifically, 8 (73%) of 11 patients experienced improvement in strength and sensation, 5 (71%) of 7 patients had improved bowel/bladder function, 3 (60%) of 5 patients had improvement of preoperative paresthesias, and no patients suffered any other long-term neurological deficits. There was improvement in Aminoff-Logue scores in 5 patients (45%), whereas in 6 motor function was stable. Two patients suffered transient neurological worsening after surgery. One had a postoperative epidural hematoma, which was promptly evacuated, without long-term sequelae. The second patient suffered global but transient neurological decline in the setting of unrelated sepsis 4 months after surgery. There were no wound infections, CSF leaks, or permanent neurological deficits.
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