Clinical Features and Outcomes of Spinal Cord Arteriovenous Malformations Comparison Between Nidus and Fistulous Types
- Authors
- Lee, Young-Jun; Terbrugge, Karel G.; Saliou, Guillaume; Krings, Timo
- Issue Date
- Sep-2014
- Publisher
- LIPPINCOTT WILLIAMS & WILKINS
- Keywords
- arteriovenous malformations; embolization; spinal cord; surgery; treatment outcome
- Citation
- STROKE, v.45, no.9, pp.2606 - 2612
- Indexed
- SCIE
SCOPUS
- Journal Title
- STROKE
- Volume
- 45
- Number
- 9
- Start Page
- 2606
- End Page
- 2612
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/159196
- DOI
- 10.1161/STROKEAHA.114.006087
- ISSN
- 0039-2499
- Abstract
- Background and Purpose-As a result of the rarity of spinal cord arteriovenous malformations (AVM), there are only a few series available that describe clinical features, outcome after treatment, and natural history of these lesions. In this article, we aim to describe our experience with both nidus-and fistulous-type spinal cord AVMs. Methods-Forty-four consecutive patients with spinal cord AVMs were retrospectively reviewed. There were 26 patients with a nidus-type and 18 patients with a fistulous-type AVM. Treatments were performed with embolization (n=23), surgery (n=13), combined embolization-surgery (n=3), or conservative management (n=5). Clinical features, radiological findings, treatment results, and clinical outcomes were assessed. Results-Patients with nidus-type AVMs were younger at presentation and more often presented with hemorrhage, with a higher proportion of hematomyelia than fistulous-type AVMs (P<0.05). Progression of clinical presentation from hemorrhage to congestive myelopathy during follow-up was noted in 5 patients, all of which had AVMs of the nidus type. Complete obliteration could be achieved more often in the fistulous type (72%) than in the nidus type (27%). Improved or stable clinical status at last follow-up was noted in 100% of fistulous-type and 77% of nidus-type patients. Long-term clinical deterioration was noted in 6 of 26 patients with nidus-type (23%) AVMs and was related to recurrent bleeding (n=3) or progressive venous congestion (n=3). Overall rebleed rate after presentation with hemorrhage was 7 in 145.5 patient-years (4.8%/y) if the lesion was not treated, 3 in 102 patient-years (2.9%/y) after partial treatment, and 0 in 47.5 patient-years (0%) after complete treatment. Conclusions-Nidus and fistulous spinal cord AVMs have different clinical features and obliteration rates, which may affect their long-term prognosis.
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