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The negative impact...
The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas : a longitudinal cohort study
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- El-Hajj, Victor Gabriel (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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- Daller, Cornelia (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.;Paracelsus Med Univ, Univ Hosp Salzburg, Dept Neurosurg, Salzburg, Austria.;Karl Landsteiner Univ Hlth Sci, Dept Neurosurg, Univ Hosp St Polten, St Polten, Austria.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria; and; Department of Neurosurgery, University Hospital St. Pölten, Karl-Landsteiner University of Health Sciences, St. Pölten, Austria
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- Fletcher-Sandersjoo, Alexander (författare)
- Karolinska Institutet,Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
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- Gharios, Maria (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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- Bydon, Mohamad (författare)
- Mayo Clin, Dept Neurol Surg, Rochester, MN USA.,Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
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- Söderman, Michael (författare)
- Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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- Jabbour, Pascal (författare)
- Thomas Jefferson Univ Hosp, Dept Neurol Surg, Philadelphia, PA USA.,Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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- Edström, Erik, 1975- (författare)
- Karolinska Institutet,Örebro universitet,Institutionen för medicinska vetenskaper,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden,Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Löwenströmska Hosp, Capio Spine Ctr Stockholm, Stockholm, Sweden.;Örebro Univ, Dept Med Sci, Örebro, Sweden.
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- Elmi-Terander, Adrian, 1971- (författare)
- Karolinska Institutet,Uppsala universitet,Ortopedi och Handkirurgi,Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Löwenströmska Hosp, Capio Spine Ctr Stockholm, Stockholm, Sweden.;Örebro Univ, Dept Med Sci, Örebro, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Capio Spine Center Stockholm, Löwenströmska Hospital, Stockholm, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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- Arnberg, Fabian (författare)
- Karolinska Institutet,Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Neuroradiol, Stockholm, Sweden.
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Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (creator_code:org_t)
- American Association of Neurological Surgeons, 2024
- 2024
- Engelska.
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Ingår i: Neurosurgical Focus. - : American Association of Neurological Surgeons. - 1092-0684. ; 56:3
- Relaterad länk:
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https://urn.kb.se/re...
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https://doi.org/10.3...
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https://urn.kb.se/re...
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http://kipublication...
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Abstract
Ämnesord
Stäng
- OBJECTIVE Dural arteriovenous fistulas are rare vascular malformations that affect the brain and spinal cord. Spinal dural arteriovenous fistulas (sdAVFs) are the most frequently encountered vascular malformation affecting the spinal cord. The object of this study was to evaluate the impact of treatment delays on the long-term neurological outcomes of either open surgical or interventional treatment of sdAVFs.METHODS In this retrospective, population-based cohort study, the authors examined consecutive patients with diagnosed sdAVFs at a tertiary care center between 2005 and 2020. Patients were assessed using the Aminoff-Logue disability scale (ALS) at various time points including symptom onset, primary care visit, first specialist outpatient visit, as well as both short and long-term follow-ups. The postoperative long-term ALS gait and bladder grades constituted the primary outcomes of the study.RESULTS Among the 34 patients included in the study, the median age was 65 years, and there was a male predominance (71%). Most lesions were in the lumbar region (47%). Significant worsening in ALS gait and bladder grades was observed preoperatively, followed by postoperative improvements (p < 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03-1.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18-12.4, p < 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00-1.01, p = 0.040) were independently associated with worse long-term gait outcomes. Only the preoperative ALS bladder score was a predictor of worse long-term bladder function (OR 92.7, 95% CI 28.0-306.7, p < 0.001).CONCLUSIONS Both surgical and endovascular treatments for sdAVFs led to significant neurological improvements. However, treatment delays were associated with less favorable long-term outcomes. Prompt diagnosis and early intervention prior to symptom progression may enhance recovery and help to preserve neurological function.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Nyckelord
- spinal dural arteriovenous fistulas
- neurological outcomes
- diagnostic delay
- treatment delay
- endovascular treatment
- surgical treatment
- gait disturbance
- bladder dysfunction
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- ref (ämneskategori)
- art (ämneskategori)
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El-Hajj, Victor ...
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Daller, Cornelia
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Fletcher-Sanders ...
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Gharios, Maria
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Bydon, Mohamad
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Söderman, Michae ...
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Jabbour, Pascal
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Edström, Erik, 1 ...
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Elmi-Terander, A ...
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Arnberg, Fabian
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- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Kirurgi
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Neurologi
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Neurosurgical Fo ...
- Av lärosätet
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Uppsala universitet
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Örebro universitet
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Karolinska Institutet