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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005930naa a2200517 4500
001oai:DiVA.org:oru-112083
003SwePub
008240304s2024 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:238427990
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-1120832 URI
0247 a https://doi.org/10.3171/2023.12.FOCUS237032 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:2384279902 URI
040 a (SwePub)orud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a El-Hajj, Victor Gabrielu Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden4 aut
2451 0a The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas :b a longitudinal cohort study
264 1b American Association of Neurological Surgeons,c 2024
338 a print2 rdacarrier
520 a 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.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653 a Bladder dysfunction
653 a diagnostic delay
653 a endovascular treatment
653 a gait disturbance
653 a neurological outcomes
653 a spinal dural arteriovenous fistulas
653 a surgical treatment
653 a treatment delay
7001 a Daller, Corneliau 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, Austria4 aut
7001 a Fletcher-Sandersjöö, Alexanderu Karolinska Institutet4 aut
7001 a Gharios, Mariau Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden4 aut
7001 a Bydon, Mohamadu Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA4 aut
7001 a Söderman, Michaelu Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden4 aut
7001 a Jabbour, Pascalu Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA4 aut
7001 a Edström, Erik,d 1975-u 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, Sweden4 aut0 (Swepub:oru)ekem
7001 a Elmi-Terander, Adrianu Karolinska Institutet4 aut
7001 a Arnberg, Fabianu Karolinska Institutet4 aut
7102 a Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Swedenb 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, Austria4 org
7730 t Neurosurgical Focusd : American Association of Neurological Surgeonsg 56:3q 56:3x 1092-0684
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-112083
8564 8u https://doi.org/10.3171/2023.12.FOCUS23703
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:238427990

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