Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas: A systematic review and meta-analysis

Jun Soo Byun, Anderson Chun On Tsang, Christopher Alan Hilditch, Patrick Nicholson, Yi Bin Fang, Timo Krings, Vitor Mendes Pereira, Giuseppe Lanzino, Waleed Brinjikji

Research output: Contribution to journalReview article

Abstract

Background and purpose Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs. Materials and methods Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes. Results There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities. Conclusions Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.

Original languageEnglish (US)
Pages (from-to)95-99
Number of pages5
JournalJournal of neurointerventional surgery
Volume11
Issue number1
DOIs
StatePublished - Jan 1 2019

Fingerprint

Arteriovenous Fistula
Meta-Analysis
Thorax
Drainage
Spine
Therapeutics
Demography
Spinal Cord Compression
Vascular Malformations
Microsurgery
Hypesthesia
PubMed
Fistula
Databases
Pain

Keywords

  • arteriovenous malformation
  • epidural
  • fistula
  • spine

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas : A systematic review and meta-analysis. / Byun, Jun Soo; Tsang, Anderson Chun On; Hilditch, Christopher Alan; Nicholson, Patrick; Fang, Yi Bin; Krings, Timo; Pereira, Vitor Mendes; Lanzino, Giuseppe; Brinjikji, Waleed.

In: Journal of neurointerventional surgery, Vol. 11, No. 1, 01.01.2019, p. 95-99.

Research output: Contribution to journalReview article

Byun, Jun Soo ; Tsang, Anderson Chun On ; Hilditch, Christopher Alan ; Nicholson, Patrick ; Fang, Yi Bin ; Krings, Timo ; Pereira, Vitor Mendes ; Lanzino, Giuseppe ; Brinjikji, Waleed. / Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas : A systematic review and meta-analysis. In: Journal of neurointerventional surgery. 2019 ; Vol. 11, No. 1. pp. 95-99.
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abstract = "Background and purpose Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs. Materials and methods Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes. Results There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6{\%}). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2{\%} and the thoracic spine in 20.8{\%}. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6{\%} vs 10.4{\%}). Of the 123 treated patients, endovascular therapy was performed in 67.5{\%} of patients, microsurgery in 23.6{\%}, and combined treatment in 8.9{\%}. The overall complete obliteration rate was 83.5{\%} and did not differ between groups. Clinical symptoms improved in 70.7{\%} of patients, were stable in 25{\%}, and worsened in 1.7{\%} with no difference between treatment modalities. Conclusions Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.",
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T1 - Presentation and outcomes of patients with thoracic and lumbosacral spinal epidural arteriovenous fistulas

T2 - A systematic review and meta-analysis

AU - Byun, Jun Soo

AU - Tsang, Anderson Chun On

AU - Hilditch, Christopher Alan

AU - Nicholson, Patrick

AU - Fang, Yi Bin

AU - Krings, Timo

AU - Pereira, Vitor Mendes

AU - Lanzino, Giuseppe

AU - Brinjikji, Waleed

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N2 - Background and purpose Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs. Materials and methods Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes. Results There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities. Conclusions Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.

AB - Background and purpose Thoracolumbar and sacral spinal epidural arteriovenous fistulas (SEDAVFs) are an increasingly recognized form of spinal vascular malformation. The purpose of this study was to perform a systematic review of the demographics, clinical presentation and treatment results of thoracolumbar SEDAVFs. Materials and methods Pubmed, Scopus and Web of Science databases were searched from January 2000 to January 2018 for articles on treatment of SEDAVFs. Pooled data of individual patients were analyzed for demographic and clinical features of SEDAVFs as well as treatment outcomes. Results There were 125 patients from 11 studies included. Mean age was 63.5 years. There was a male sex predilection (69.6%). Sensory symptoms including pain or numbness were the most frequently presenting symptoms. Fistula location was the lumbosacral spine in 79.2% and the thoracic spine in 20.8%. Involvement of intradural venous drainage was more common than extradural venous drainage only (89.6% vs 10.4%). Of the 123 treated patients, endovascular therapy was performed in 67.5% of patients, microsurgery in 23.6%, and combined treatment in 8.9%. The overall complete obliteration rate was 83.5% and did not differ between groups. Clinical symptoms improved in 70.7% of patients, were stable in 25%, and worsened in 1.7% with no difference between treatment modalities. Conclusions Thoracic and lumbosacral SEDAVFs often present with symptoms secondary to congestive myelopathy or compressive symptoms. Both endovascular and microsurgical treatments were associated with high obliteration rates and good clinical outcomes.

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KW - epidural

KW - fistula

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