{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T09:03:37Z","timestamp":1788080617077,"version":"build-2784847793"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>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 &lt; 0.05). There was no difference in outcomes between surgical and endovascular treatments. Older age (OR 1.10, 95% CI 1.03\u20131.17, p = 0.007), worse preoperative ALS gait grades (OR 5.12, 95% CI 2.18\u201312.4, p &lt; 0.001), and longer time from first specialist outpatient visit to first treatment (OR 1.00, 95% CI 1.00\u20131.01, 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\u2013306.7, p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.12.focus23703","type":"journal-article","created":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T07:00:54Z","timestamp":1709276454000},"page":"E14","source":"Crossref","is-referenced-by-count":8,"title":["The negative impact of treatment delays on the long-term neurological outcomes of spinal dural arteriovenous fistulas: a longitudinal cohort study"],"prefix":"10.3171","volume":"56","author":[{"given":"Victor Gabriel","family":"El-Hajj","sequence":"first","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelia","family":"Daller","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"},{"name":"Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden;"},{"name":"Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University Salzburg, Austria; and"},{"name":"Department of Neurosurgery, University Hospital St. P\u00f6lten, Karl-Landsteiner University of Health Sciences, St. P\u00f6lten, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fletcher-Sandersj\u00f6\u00f6","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Gharios","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad","family":"Bydon","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"S\u00f6derman","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"},{"name":"Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Edstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"},{"name":"Capio Spine Center Stockholm, L\u00f6wenstr\u00f6mska Hospital, Stockholm, Sweden;"},{"name":"Department of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrian","family":"Elmi-Terander","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"},{"name":"Capio Spine Center Stockholm, L\u00f6wenstr\u00f6mska Hospital, Stockholm, Sweden;"},{"name":"Department of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden;"},{"name":"Department of Surgical Sciences, Uppsala University, Uppsala, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Arnberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;"},{"name":"Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"11","key":"b1","series-title":"Radiologe","first-page":"955","article-title":"Spinal dural arteriovenous fistulas. 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Spinal dural arteriovenous fistulas\u2014an underdiagnosed disease. A review of patients admitted to the spinal unit of a rehabilitation center. J Neurol. 2006;253(2):159\u2013162."},{"issue":"4","key":"b4","series-title":"AJNR Am J Neuroradiol","first-page":"639","article-title":"Spinal dural arteriovenous fistulas","volume":"30","author":"Krings T","year":"2009","unstructured":"Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30(4):639\u2013648."},{"issue":"10","key":"b5","series-title":"Stroke","first-page":"2783","article-title":"Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations","volume":"39","author":"Geibprasert S","year":"2008","unstructured":"Geibprasert S, Pereira V, Krings T,  Dural arteriovenous shunts: a new classification of craniospinal epidural venous anatomical bases and clinical correlations. 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Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients. Stroke. 2002;33(6):1578\u20131583."},{"issue":"10","key":"b15","series-title":"J Neurol Neurosurg Psychiatry","first-page":"1438","article-title":"Spinal dural arteriovenous fistulas: clinical features in 80 patients","volume":"74","author":"Jellema K","year":"2003","unstructured":"Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J. Spinal dural arteriovenous fistulas: clinical features in 80 patients. 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