2025 Volume 16 Issue 7 Pages 960-965
Introduction: Dural arteriovenous fistulas (dural AVFs) and epidural arteriovenous fistulas (epidural AVFs) are spinal vascular malformations that cause venous hypertension due to arteriovenous shunting, leading to myelopathy. Although surgical interruption of the draining vein is an effective treatment, the differences in surgical outcomes based on anatomical location remain unclear. This study aimed to compare surgical outcomes between thoracic and lumbar AVFs.
Methods: A total of 28 patients (20 males, 8 females; mean age at surgery, 68 years) who underwent surgical treatment for AVFs in the thoracic or lumbar spine at our hospital from May 2011 to June 2023 were included. Patients were divided into two groups based on the location of the arteriovenous shunt: the thoracic group (n=13) and the lumbar group (n=15). Group comparisons were performed with statistical significance set at p < 0.05.
Results: All 13 cases in the thoracic group had dural AVFs with dorsal dural penetration of the draining vein. In contrast, 14 of the 15 cases (93%) in the lumbar group had epidural AVF, and 13 of 15 cases (87%) exhibited ventral dural penetration of the draining vein (p < 0.001). The median operation time was significantly longer in the lumbar group (230 minutes) than in the thoracic group (147 minutes) (p < 0.05), while the median intraoperative blood loss did not significantly differ between the groups (thoracic vs. lumbar groups, 100 ml vs. 160 ml, respectively; p = 0.18). Two cases in the lumbar group required revision surgery due to failure to interrupt the draining vein during the initial procedure. In both groups, magnetic resonance imaging findings, gait function, and bladder function significantly improved and were maintained until the final follow-up.
Conclusions: Surgical outcomes were favorable in both the thoracic and lumbar groups. However, the lumbar group exhibited a higher incidence of epidural AVFs with varying dural penetration sites of the draining vein, complicating identification and interruption. Therefore, lumbar AVFs necessitate more careful assessment and surgical planning compared to thoracic AVFs.
