Analysis of the efficacy and influencing factors of hybrid surgery in the treatment of spinal dural arteriovenous fistula
Objective To observe the efficacy of hybrid surgery in the treatment of spinal dural arteriovenous fistula(SDAVF),and to explore the related factors affecting patient prognosis.Methods The clinical data of 76 SDAVF patients admitted to the Neurosurgery Department of Tianjin Medical University General Hospital from January 2018 to January 2022 were retrospectively analyzed.All patients underwent hybrid surgery to cut off the SDAVF drainage vessels.MRI was used to observe the changes in spinal cord edema segments,edema cross-sectional area ratio,and major and minor diameters of edema;modified Aminoff and Logue score(mALS)was used to evaluate spinal cord neurological function,including thALS total score,lower limb motor function score and urination.and defecätion function score;a decrease of≥2 in the total mALS score 12 months after surgery compared to preoperative was considered improvement,a decrease of＜2 was considered no significant improvement,and an increase of≥2 was considered worsening.The differences in clinical data of patients with different outcomes were analyzed,and multivariate logistic regression analysis was used to analyze the related factors affecting patient outcomes.Results The postoperative follow-up time[M(Q1,Q3)]of 76 patients was 15.0(13.5,20.0)months.MRI showed that spinal cord edema and tortuous vascular shadows improved in all patients after surgery,and no case recurred.Twelve months after surgery,among 76 patients,mALS improved in 33 patients(43.4％)and had no significant improvement in 43 patients(56.6％).Compared with the group without significant improvement,the patients in the improvement group had shorter disease duration,lower preoperative mALS total score and gait score,and fewer preoperative edema segments,and the differences were statistically significant(all P＜0.05).However,there were no statistically significant differences in age,gender,fistula location,preoperative urinary and defecation function scores,or the ratio of major diameter,minor diameter,and cross-sectional area of spinal cord edema(all P＞0.05).Multivariate logistic regression analysis showed that short disease duration(OR=0.92,95％CI:0.86-0.99,P=0.028)and low preoperative mALS total score(OR=0.76,95％CI:0.59-0.99,P=0.043)and a small number of spinal cord edema segments(OR=0.78,95％CI:0.62-0.98,P=0.035)were related to good outcome of the patient(all P＜0.05).Conclusions After hybrid surgery for SDAVF,spinal cord neurological function recovers better after surgery.Short course of disease,low preoperative mALS and few spinal cord edema segments are important factors influencing the patient's good prognosis.
Spinal cord vascular diseasesArteriovenous fistulaTreatment outcomeRoot cause analysisHybrid operation
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