The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts
| العنوان: | The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts |
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| المؤلفون: | Guilin Li, Tao Hong, Hongqi Zhang, Ming Ye, Fan Yang, Li-Song Bian, Jia-Xing Yu, Chuan He, Xiao-Dong Zhai, Feng Ling |
| المصدر: | Brain. 144:3381-3391 |
| بيانات النشر: | Oxford University Press (OUP), 2021. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Arteriovenous fistula, Young Adult, Myelopathy, Aneurysm, medicine, Humans, Embolization, Retrospective Studies, Central Nervous System Vascular Malformations, business.industry, Vascular malformation, Arteriovenous malformation, Microsurgery, medicine.disease, Spinal cord, Embolization, Therapeutic, Surgery, Treatment Outcome, medicine.anatomical_structure, Spinal Cord, Female, Neurology (clinical), business, Vascular Surgical Procedures |
| الوصف: | Contemporary treatments for spinal cord arteriovenous shunts are only based on clinicians’ treatment experiences and expertise due to its rarity. We reviewed the clinical course of the largest multicentred cohort to evaluate the efficacy and deficiency of contemporary interventional treatments for spinal cord arteriovenous shunts. The clinical features, treatment results and clinical outcomes of 463 patients with spinal cord arteriovenous shunts were retrospectively assessed. The main outcome was the neurological deterioration that was evaluated based on the modified Aminoff and Logue scale. According to post-treatment digital subtraction angiography, complete obliteration was defined as disappearance of the intradural lesion, whereas partial obliteration was defined as any residual intradural lesion remaining visible and was further categorized as shunt-reduction obliteration (the nidus or shunt points were reduced) or palliative obliteration (only obliterated aneurysms or feeders). Cure rate was 40.6% for the whole cohort, 58.5% after microsurgery, and 26.4% after embolization. The curative resection was associated with non-metameric lesions, lesions with a maximum diameter Although clinical risks of spinal cord arteriovenous shunts were reduced following clinical interventions, contemporary treatments for spinal cord arteriovenous shunt remains associated with considerable risks and incomplete efficacy. Individualized treatment plans should be adopted according to the angio-architectural features and major clinical risks of specific lesions. There is a higher opportunity for complete obliteration for lesions with simple angio-architecture. However, for most of spinal cord arteriovenous shunts with complex vascular anatomy, partial treatment is the only choice. For these patients, palliative obliteration targeting the aneurysms is recommended for reducing haemorrhagic risk, whereas shunt-reduction obliteration is necessary for non-haemorrhagic myelopathy. Contemporary treatment is ineffective in reducing haemorrhagic risk of incurable metameric spinal cord arteriovenous shunts. |
| تدمد: | 1460-2156 0006-8950 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0a530e9b89a9e171e6edc280965544fa https://doi.org/10.1093/brain/awab237 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....0a530e9b89a9e171e6edc280965544fa |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14602156 00068950 |
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