{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T10:24:55Z","timestamp":1794219895372,"version":"4.8.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Arteriovenous shunts below the conus medullaris (AVS-BC) have an unstudied natural history. The aim of this study was to elucidate the natural history of AVS-BC and to clarify the clinical onset, progression, and treatment outcomes for management strategy optimization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A prospectively maintained database was retrospectively reviewed for consecutive symptomatic patients with AVS-BC between January 2000 and July 2023. Onset and deterioration patterns were categorized as acute or gradual and assessed using the modified Aminoff-Logue Scale (mALS) and modified Denis Pain and Numbness Scale (mDS). Time to deterioration before and after treatment was evaluated using Kaplan-Meier analysis, restricted cubic splines, and Cox and logistic regression modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The analysis included 132 patients (113 male, median age 54.5 years) with AVS-BC, with a median observational period of 9.00 months (IQR 5.25\u201312.00 months). Acute onset occurred in 18.2% of patients, with 16.7% experiencing acute deterioration. The overall pretreatment deterioration rate was 6.5% per month. Deterioration risk was highest shortly after the initial onset. Patients aged 50\u201370 years were less likely to experience deterioration (p = 0.02). Half the patients underwent embolization and 43.9% underwent microsurgery, with an anatomical cure achieved in most patients. The overall monthly deterioration rate after treatment was 0.5%. The mALS grade at admission was a significant risk factor for spinal motor deterioration (HR 0.60, 95% CI 0.45\u20130.79; p &lt; 0.001). For sensory deterioration, risk factors included dural AVS-BC (HR 2.98, 95% CI 1.02\u20138.69; p = 0.046), a drainage diameter of 1.5\u20132.0 mm (HR 2.48, 95% CI 1.05\u20135.84; p = 0.038), and the admission mDS score (HR 1.66, 95% CI 1.24\u20132.21; p &lt; 0.001). Deeper segments (L5\u2013S1, HR 2.70, p = 0.024; S2\u20135, HR 13.00, p &lt; 0.001) predicted embolization as the treatment modality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Rapid deterioration was observed among patients with AVS-BC, particularly after onset. While early treatments were beneficial for most patients, gradual deterioration after treatment warrants further research.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.11.jns251606","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T01:44:27Z","timestamp":1775267067000},"page":"454-465","source":"Crossref","is-referenced-by-count":0,"title":["Natural course and treatment outcomes of arteriovenous shunts below the conus medullaris"],"prefix":"10.3171","volume":"145","author":[{"given":"Yu-xiang","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"Department of Neurosurgery, China-Japan Friendship Hospital, Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-bin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gui-lin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-wei","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Song","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Beijing Haidian Hospital, Beijing; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-chen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neuro-oncology, Cancer Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong-jie","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-qi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing;"},{"name":"International Neuroscience Institute (China-INI), Beijing;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Clin Neuroradiol","first-page":"5","article-title":"Vascular malformations of the spine and spinal cord: anatomy, classification, treatment","volume":"20","author":"Krings T","year":"2010","unstructured":"Krings T. Vascular malformations of the spine and spinal cord: anatomy, classification, treatment. Clin Neuroradiol. 2010;20(1):5\u201324. doi:10.1007\/s00062-010-9036-6"},{"issue":"4","key":"b2","series-title":"Stroke","first-page":"1455","article-title":"Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan","volume":"52","author":"Murai S","year":"2021","unstructured":"Murai S, Hiramatsu M, Suzuki E,  Trends in incidence of intracranial and spinal arteriovenous shunts: hospital-based surveillance in Okayama, Japan. Stroke. 2021;52(4):1455\u20131459. doi:10.1161\/STROKEAHA.120.032052"},{"issue":"1","key":"b3","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Tethered cord syndrome: a review of the literature from embryology to adult presentation","volume":"29","author":"Hertzler DA II","year":"2010","unstructured":"Hertzler DA II, DePowell JJ, Stevenson CB, Mangano FT. Tethered cord syndrome: a review of the literature from embryology to adult presentation. Neurosurg Focus. 2010;29(1):E1. doi:10.3171\/2010.3.FOCUS1079"},{"issue":"6","key":"b4","series-title":"Neurosurgery","first-page":"1500","article-title":"Retained medullary cord in humans: late arrest of secondary neurulation","volume":"68","author":"Pang D","year":"2011","unstructured":"Pang D, Zovickian J, Moes GS. Retained medullary cord in humans: late arrest of secondary neurulation. Neurosurgery. 2011;68(6):1500\u20131519. doi:10.1227\/NEU.0b013e31820ee282"},{"issue":"3","key":"b5","series-title":"Pediatr Neurosurg","first-page":"236","article-title":"Tethered cord syndrome: an updated review","volume":"43","author":"Lew SM","year":"2007","unstructured":"Lew SM, Kothbauer KF. Tethered cord syndrome: an updated review. Pediatr Neurosurg. 2007;43(3):236\u2013248. doi:10.1159\/000098836"},{"issue":"3","key":"b6","series-title":"Neurosurgery","first-page":"E598","article-title":"Paraplegia after tethered cord surgery: an uncommon combined anomaly of spinal arteriovenous fistula and sacral lipoma\u2014case report","volume":"57","author":"Cheung AC","year":"2005","unstructured":"Cheung AC, Kalkanis SN, Ogilvy CS. Paraplegia after tethered cord surgery: an uncommon combined anomaly of spinal arteriovenous fistula and sacral lipoma\u2014case report. Neurosurgery. 2005;57(3):E598. doi:10.1227\/01.neu.0000171028.96829.69"},{"issue":"12","key":"b7","series-title":"Asian J Surg","first-page":"5683","article-title":"The coincidence of arteriovenous fistula, tethered cord, and filum terminale lipoma: a case report and literature review","volume":"46","author":"Huang HZ","year":"2023","unstructured":"Huang HZ, Xia Y, Chen LH. The coincidence of arteriovenous fistula, tethered cord, and filum terminale lipoma: a case report and literature review. Asian J Surg. 2023;46(12):5683\u20135684. doi:10.1016\/j.asjsur.2023.08.079"},{"issue":"8","key":"b8","series-title":"Brain","first-page":"2265","article-title":"Natural history of spinal cord arteriovenous shunts: an observational study","volume":"142","author":"Yu JX","year":"2019","unstructured":"Yu JX, Hong T, Krings T,  Natural history of spinal cord arteriovenous shunts: an observational study. Brain. 2019;142(8):2265\u20132275. doi:10.1093\/brain\/awz153"},{"issue":"11","key":"b9","series-title":"Brain","first-page":"3381","article-title":"The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts","volume":"144","author":"Yu JX","year":"2021","unstructured":"Yu JX, He C, Ye M,  The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts. Brain. 2021;144(11):3381\u20133391. doi:10.1093\/brain\/awab237"},{"issue":"e1","key":"b10","series-title":"J Neurointerv Surg","first-page":"e124","article-title":"Intraoperative direct venous puncture and embolization for arteriovenous shunt below the conus medullaris: a prospective cohort study","volume":"17","author":"Fan Y","year":"2024","unstructured":"Fan Y, Yang C, Meng X,  Intraoperative direct venous puncture and embolization for arteriovenous shunt below the conus medullaris: a prospective cohort study. J Neurointerv Surg. 2024;17(e1):e124-e131. doi:10.1136\/jnis-2023-020988"},{"issue":"2","key":"b11","series-title":"AJNR Am J Neuroradiol","first-page":"403","article-title":"Comparison of 3 different types of spinal arteriovenous shunts below the conus in clinical presentation, radiologic findings, and outcomes","volume":"38","author":"Hong T","year":"2017","unstructured":"Hong T, Park JE, Ling F,  Comparison of 3 different types of spinal arteriovenous shunts below the conus in clinical presentation, radiologic findings, and outcomes. AJNR Am J Neuroradiol. 2017;38(2):403\u2013409. doi:10.3174\/ajnr.A5001"},{"issue":"2","key":"b12","series-title":"Lancet Neurol","first-page":"117","article-title":"The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data","volume":"20","author":"Badhiwala JH","year":"2021","unstructured":"Badhiwala JH, Wilson JR, Witiw CD,  The influence of timing of surgical decompression for acute spinal cord injury: a pooled analysis of individual patient data. Lancet Neurol. 2021;20(2):117\u2013126. doi:10.1016\/S1474-4422(20)30406-3"},{"issue":"20","key":"b13","series-title":"Stat Med","first-page":"3735","article-title":"Comparing smoothing techniques in Cox models for exposure-response relationships","volume":"26","author":"Govindarajulu US","year":"2007","unstructured":"Govindarajulu US, Spiegelman D, Thurston SW, Ganguli B, Eisen EA. Comparing smoothing techniques in Cox models for exposure-response relationships. Stat Med. 2007;26(20):3735\u20133752. doi:10.1002\/sim.2848"},{"issue":"3","key":"b14","series-title":"Eur J Radiol","first-page":"221","article-title":"Spinal cord arteriovenous shunts: from imaging to management","volume":"46","author":"Rodesch G","year":"2003","unstructured":"Rodesch G, Lasjaunias P. Spinal cord arteriovenous shunts: from imaging to management. Eur J Radiol. 2003;46(3):221\u2013232. doi:10.1016\/s0720-048x(03)00093-7"},{"issue":"3","key":"b15","series-title":"J Clin Med","first-page":"711","article-title":"Delayed diagnosis of spinal dural arteriovenous fistula: a case report and scoping review","volume":"13","author":"Tanaka T","year":"2024","unstructured":"Tanaka T, Yamane F, Sashida R,  Delayed diagnosis of spinal dural arteriovenous fistula: a case report and scoping review. J Clin Med. 2024;13(3):711. doi:10.3390\/jcm13030711"},{"issue":"1","key":"b16","series-title":"Neurosurgery","first-page":"E219","article-title":"Perimedullary arteriovenous fistula of the filum terminale: case report","volume":"66","author":"Jin YJ","year":"2010","unstructured":"Jin YJ, Kim KJ, Kwon OK, Chung SK. Perimedullary arteriovenous fistula of the filum terminale: case report. Neurosurgery. 2010;66(1):E219\u2013E220. doi:10.1227\/01.NEU.0000359529.40577.A1"},{"issue":"12","key":"b17","series-title":"Neurol Med Chir (Tokyo)","first-page":"896","article-title":"Spinal epidural arteriovenous fistulas with unusual manifestation of sudden onset of severe neurological deficits: case report","volume":"53","author":"Miyamoto N","year":"2013","unstructured":"Miyamoto N, Naito I, Takatama S, Iwai T, Tomizawa S, Inoue HK. Spinal epidural arteriovenous fistulas with unusual manifestation of sudden onset of severe neurological deficits: case report. Neurol Med Chir (Tokyo). 2013;53(12):896\u2013901. doi:10.2176\/nmc.cr2012-0269"},{"key":"b18","series-title":"World Neurosurg","first-page":"295","article-title":"Intramedullary hemorrhage caused by lumbosacral epidural arteriovenous fistula with dual retrograde perimedullary venous draining routes: a case report and review of the literature","volume":"143","author":"Iampreechakul P","year":"2020","unstructured":"Iampreechakul P, Liengudom A, Wangtanaphat K, Narischat P, Lertbutsayanukul P, Siriwimonmas S. Intramedullary hemorrhage caused by lumbosacral epidural arteriovenous fistula with dual retrograde perimedullary venous draining routes: a case report and review of the literature. World Neurosurg. 2020;143:295\u2013307. doi:10.1016\/j.wneu.2020.08.025"},{"key":"b19","series-title":"Springer Berlin Heidelberg","first-page":"73","article-title":"Spinal and spinal cord arteries and veins","author":"Lasjaunias P","year":"2001","unstructured":"Lasjaunias P, Berenstein A, ter Brugge KG. Spinal and spinal cord arteries and veins. In: Lasjaunias P, Berenstein A, ter Brugge KG, eds.Clinical Vascular Anatomy and Variations. Springer Berlin Heidelberg;2001:73\u2013164. doi:10.1007\/978-3-662-10172-8_2"},{"issue":"3","key":"b20","series-title":"Neurosurgery","first-page":"709","article-title":"A novel rat model of venous hypertensive myelopathy produced by arteriovenous bypass plus venous stenosis","volume":"95","author":"Wang Y","year":"2024","unstructured":"Wang Y, Yang C, Wang J,  A novel rat model of venous hypertensive myelopathy produced by arteriovenous bypass plus venous stenosis. Neurosurgery. 2024;95(3):709\u2013721. doi:10.1227\/neu.0000000000002926"},{"issue":"4","key":"b21","series-title":"J Neurointerv Surg","first-page":"415","article-title":"Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge - single-centre experience of 13 cases and review of the literature","volume":"10","author":"Gioppo A","year":"2018","unstructured":"Gioppo A, Farag\u00f2 G, Giannitto C,  Sacral dural arteriovenous fistulas: a diagnostic and therapeutic challenge - single-centre experience of 13 cases and review of the literature. J Neurointerv Surg. 2018;10(4):415\u2013421. doi:10.1136\/neurintsurg-2017-013307"},{"issue":"10","key":"b22","series-title":"Spinal Cord","first-page":"520","article-title":"Spinal cord infarction: prognosis and recovery in a series of 36 patients","volume":"39","author":"Salvador de la Barrera S","year":"2001","unstructured":"Salvador de la Barrera S, Barca-Buyo A, Montoto-Marqu\u00e9s A, Ferreiro-Velasco ME, Cidoncha-Dans M, Rodriguez-Sotillo A. Spinal cord infarction: prognosis and recovery in a series of 36 patients. Spinal Cord. 2001;39(10):520\u2013525. doi:10.1038\/sj.sc.3101201"},{"issue":"10","key":"b23","series-title":"Stroke","first-page":"2792","article-title":"Spinal arteriolosclerosis is common in older adults and associated with parkinsonism","volume":"48","author":"Buchman AS","year":"2017","unstructured":"Buchman AS, Leurgans SE, Nag S,  Spinal arteriolosclerosis is common in older adults and associated with parkinsonism. Stroke. 2017;48(10):2792\u20132798. doi:10.1161\/STROKEAHA.117.017643"},{"issue":"1","key":"b24","series-title":"Neurosurg Focus","first-page":"E16","article-title":"Arteriovenous malformations of the filum terminale: clinical characteristics, angioarchitecture, and management of a rare spinal vascular pathology","volume":"53","author":"Mull M","year":"2022","unstructured":"Mull M, Dafotakis M, Schubert GA, Hans FJ, Jablawi F. Arteriovenous malformations of the filum terminale: clinical characteristics, angioarchitecture, and management of a rare spinal vascular pathology. Neurosurg Focus. 2022;53(1):E16. doi:10.3171\/2022.4.FOCUS2289"},{"issue":"3","key":"b25","series-title":"J Neurosurg Spine","first-page":"487","article-title":"Clinical and radiographic characteristics of sacral arteriovenous fistulas: a multicenter experience","volume":"36","author":"Domingo RA","year":"2022","unstructured":"Domingo RA, De Biase G, Navarro R,  Clinical and radiographic characteristics of sacral arteriovenous fistulas: a multicenter experience. J Neurosurg Spine. 2022;36(3):487\u2013497. doi:10.3171\/2021.5.SPINE21119"},{"issue":"3","key":"b26","series-title":"Neurosurgery","first-page":"E780","article-title":"Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report","volume":"69","author":"Witiw CD","year":"2011","unstructured":"Witiw CD, Fallah A, Radovanovic I, Wallace MC. Sacral intradural arteriovenous fistula treated indirectly by transection of the filum terminale: technical case report. Neurosurgery. 2011;69(3):E780\u2013E784. doi:10.1227\/NEU.0b013e31821bc64c"},{"key":"b27","series-title":"Clin Neurol Neurosurg","first-page":"105596","article-title":"Treatment strategy and long-term outcome in patients with deep lumbosacral arteriovenous fistulas. A single center analysis in nineteen patients","volume":"188","author":"Jablawi F","year":"2020","unstructured":"Jablawi F, Nikoubashman O, Dafotakis M, Schubert GA, Hans FJ, Mull M. Treatment strategy and long-term outcome in patients with deep lumbosacral arteriovenous fistulas. A single center analysis in nineteen patients. Clin Neurol Neurosurg. 2020;188:105596. doi:10.1016\/j.clineuro.2019.105596"},{"issue":"4","key":"b28","series-title":"World Neurosurg","first-page":"401","article-title":"Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain","volume":"73","author":"Shinoyama M","year":"2010","unstructured":"Shinoyama M, Endo T, Takahash T,  Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain. World Neurosurg. 2010;73(4):401\u2013408. doi:10.1016\/j.wneu.2010.01.003"},{"issue":"1","key":"b29","series-title":"J Neurosurg Spine","first-page":"85","article-title":"Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas","volume":"29","author":"Safaee MM","year":"2018","unstructured":"Safaee MM, Clark AJ, Burkhardt JK, Winkler EA, Lawton MT. Timing, severity of deficits, and clinical improvement after surgery for spinal dural arteriovenous fistulas. J Neurosurg Spine. 2018;29(1):85\u201391. doi:10.3171\/2017.11.SPINE17988"},{"issue":"4","key":"b30","series-title":"J Neurosurg Spine","first-page":"485","article-title":"The pathophysiology of venous hypertensive myelopathy\u2014study of an animal model: laboratory investigation","volume":"19","author":"Zhang HQ","year":"2013","unstructured":"Zhang HQ, Chen T, Wu SS,  The pathophysiology of venous hypertensive myelopathy\u2014study of an animal model: laboratory investigation. J Neurosurg Spine. 2013;19(4):485\u2013491. doi:10.3171\/2013.6.SPINE11860"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p454.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p454.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/145\/2\/article-p454.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T09:55:41Z","timestamp":1794218141000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/145\/2\/article-p454.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,1]]},"references-count":30,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2025.11.jns251606","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,1]]}}}