INTRODUCTION: The prognosis of untreated spinal dural arteriovenous fistulas (SDAVFs) is unfavorable. Current outcome scales used to assess the effect of surgery or endovascular treatment (EVT) rely largely on patient-reported symptoms and may underestimate actual impairment. Moreover, prognostic factors remain debated and conclusions in the literature are inconsistent. RESEARCH QUESTION: The aim was to quantify urological outcomes after SDAVF embolization using specialized urodynamic testing, compare these objective findings with subjective outcomes derived from traditional scales, and identify prognostic factors associated with unfavorable clinical results. METHODS: In this single-center retrospective study, all patients underwent EVT as first-line therapy. Clinical status was assessed using Aminoff-Logue scale (ALS), compared with preoperative data, and correlated with angiographic findings. Urodynamic testing was performed to objectively evaluate bladder function. RESULTS: Twent-four patients met the inclusion criteria. Urodynamic testing was performed in 14 (58 %) patients. The most frequent abnormal finding was bladder hyposensitivity (79 %), followed by pathological post-void residual volume (64 %) and elevated bladder capacity (50 %). Six (43 %) patients reported no subjective urological symptoms (ALS = 0); urodynamic testing revealed two or more pathological parameters in all of them. EVT failure and subsequent surgery predicted gait deterioration (p = 0.011) as well as detrusor overactivity (p = 0.001). Symptom duration over one year (p = 0.038) and fistula location above the T9 level (p = 0.021) were negative prognostic factors for bladder function. CONCLUSION: The results suggest a potential underestimation of urological impairment when relying on subjective scales and highlight the need for standardized urodynamic testing. They also emphasize the importance of early treatment of SDAVF.

Department of Neurosurgery and Neurooncology 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Radiology Military University Hospital Prague Czech Republic

Department of Urology 1st Faculty of Medicine Charles University and Military University Hospital Prague Czech Republic

Department of Urology 3rd Faculty of Medicine Charles University and University Hospital Královské Vinohrady Prague Czech Republic

Zobrazit více v PubMed

Aminoff M.J., Logue V. The prognosis of patients with spinal vascular malformations. Brain. 1974;97:211–218. PubMed

Bakker N.A., et al. Recurrence rates after surgical or endovascular treatment of spinal dural arteriovenous fistulas: a meta-analysis. Neurosurgery. 2015;77:137–144. PubMed

Behrens S., Thron A. Long-term follow-up and outcome in patients treated for spinal dural arteriovenous fistula. J. Neurol. 1999;246:181–185. PubMed

Cenzato M., et al. Spinal dural arteriovenous fistulas: outcome and prognostic factors. Neurosurg. Focus. 2012;32 PubMed

da Costa L., Dehdashti A.R., TerBrugge K.G. Spinal cord vascular shunts: spinal cord vascular malformations and dural arteriovenous fistulas. Neurosurg. Focus. 2009;26 PubMed

Endo T., Endo H., Sato K. Surgical and endovascular treatment for spinal arteriovenous malformations. Neurol. Med.-Chir. 2016;56:457–464. PubMed PMC

Fugate J.E., Lanzino G., Rabinstein A.A. Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview. Neurosurg. Focus. 2012;32:E17. PubMed

Gemmete J.J., et al. Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers. Am. J. Neuroradiol. 2013;34 PubMed PMC

Goyal A., et al. Outcomes following surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis. J. Neurol. Neurosurg. Psychiatry. 2019;90:1139–1146. PubMed

Gross B.A., Albuquerque F.C., Moon K., McDougall C.G. Validation of an ‘endovascular-first’ approach to spinal dural arteriovenous fistulas: an intention-to-treat analysis. J. Neurointerventional Surg. 2017;9:102–105. PubMed

Jablawi F., Schubert G.A., Hans F.J., Mull M. Anticoagulation therapy after surgical treatment of spinal dural arteriovenous fistula. Effectiveness and long-term outcome analysis. World Neurosurg. 2018;114:698–705. PubMed

Jellema K., Tijssen C.C., Gijn J. Van. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain. 2006;129:3150–3164. PubMed

Kataoka H., Miyamoto S., Nagata I., Ueba T., Hashimoto N. Venous congestion is a major cause of neurological deterioration in spinal arteriovenous malformations. Neurosurgery. 2001;48:1224–1230. PubMed

Kirsch M., Berg-Dammer E., Musahl C. Endovascular management of spinal dural arteriovenous fistulas in 78 patients. Neuroradiology. 2013;55:337–343. PubMed

Koch M.J., Stapleton C.J., Agarwalla P.K. Open and endovascular treatment of spinal dural arteriovenous fistulas: a 10-year experience. J. Neurosurg. Spine. 2017;26:519–523. PubMed

Mccutcheon I.E., Doppman J.L., Oldfield E.H. Microvascular anatomy of dural arteriovenous abnormalities of the spine: a microangiographic study. J. Neurosurg. 1996;84:215–220. PubMed

Muralidharan R., Saladino A., Lanzino G., Atkinson J.L., Rabinstein A.A. The clinical and radiological presentation of spinal dural arteriovenous fistula. Spine. 2011;36:1641–1647. PubMed

Narvid J., et al. Spinal dural arteriovenous fistulae: clinical features and long-term results. Neurosurgery. 2008;62:159–166. PubMed

Ofran Y., et al. Correlation between time to diagnosis and rehabilitation outcomes in patients with spinal dural arteriovenous fistula. J. Spinal Cord Med. 2013;36:200–206. PubMed PMC

Peng Y., et al. Clinical outcomes and prognostic factors in the surgical treatment of spinal dural arteriovenous fistulas: a retrospective study of 118 patients. Sci. Rep. 2023;13:1–8. PubMed PMC

Ronald A.A., et al. Spinal dural arteriovenous fistula: diagnosis, outcomes, and prognostic factors. World Neurosurg. 2020;144:306–315. PubMed

Ropper A.E., Gross B.A., Du R. Surgical treatment of type I spinal dural arteriovenous fistulas. Neurosurg. Focus. 2012;32 PubMed

Song J.K., et al. Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors. J. Neurosurg. Spine. 2001;94:199–204. PubMed

Spetzler R.F., Detwiler P.W., Riina H.A., Porter R.W. Modified classification of spinal cord vascular lesions. J. Neurosurg. 2002;96:145–156. PubMed

Steinmetz M.P., et al. Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery. 2004;55:77–87. PubMed

Voldřich R., Charvát F., Malík J., Netuka D. Evaluating the role of onyx embolization in the management of spinal dural arteriovenous fistulas: a 20-Year single-center experience. World Neurosurg. 2025;198 PubMed

Yang C., et al. Long-term outcomes and prognostic factors in patients with treated spinal dural arteriovenous fistulas: a prospective cohort study. BMJ Open. 2022;12 PubMed PMC