Dural Arteriovenous Fistula and Foix-Alajouanine Syndrome: Assessment of Functional Scores with Review of Pathogenesis.

World Neurosurg

Department of Neurosurgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Head and Neck Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Jonsson Comprehensive Cancer Center, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA; Department of Neurosurgery, Harbor-UCLA Medical Center, Torrance, California, USA; Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA. Electronic address:

Published: October 2017

AI Article Synopsis

  • The study aimed to evaluate functional scores in patients with dural arteriovenous fistula and Foix-Alajouanine syndrome using established scoring systems (ALS and mRS) to create a new score called the Aminoff-Rankin Composite (ARC).
  • Researchers analyzed data from 18 patients, comparing outcomes between those who underwent surgery versus those who had embolization, finding no significant difference in overall functional scores or symptom improvement between the two treatments.
  • Results indicated that higher pre-intervention functional scores correlated with better symptom improvement post-treatment, suggesting effective diagnosis and management can lead to enhanced patient outcomes reflected in lower functional scores.

Article Abstract

Objective: To assess the use of functional scores in the evaluation of patients with dural arteriovenous fistula and Foix-Alajouanine syndrome.

Methods: We systematically surveyed the literature to identify relevant patients. Aminoff-Logue Scale (ALS) and modified Rankin Scale (mRS) scores were ascertained and combined to form a novel functional score, the Aminoff-Rankin Composite (ARC) score. We compared functional scores between surgery and embolization groups and ran one-sided point-biserial analyses to test our expectation that positive correlations exist between functional scores and treatment outcomes. Finally, we reviewed the pathogenesis of dural arteriovenous fistula formation.

Results: The quantitative synthesis included 18 patients. Surgery alone was performed in 11 patients (61.11%); 7 patients underwent embolization alone (38.89%). There were no significant differences in functional scores or symptom outcomes when we compared surgery to embolization. The pre-intervention ALS gait, mRS, and ARC scores were correlated with improved symptoms (r = 0.43, P = 0.04; r = 0.47, P = 0.02; r = 0.48, P = 0.04, respectively). In patients whose symptoms were improved, post-intervention ALS gait and micturition scores (2.55 vs. 4.43, P = 0.02 and 1.09 vs. 2.71, P = 0.01, respectively) and post-intervention ARC scores (6.66 vs. 11.57, P = 0.01) were on average lower than in patients whose symptoms were unimproved.

Conclusions: We believe that patients with dAVF and Foix-Alajouanine syndrome present with worse function (higher functional scores) as a result of an acute myelopathic episode, and that if diagnosed and treated appropriately, will experience some level of symptom improvement that is evidenced by reduced post-intervention functional scores.

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Source
http://dx.doi.org/10.1016/j.wneu.2017.06.141DOI Listing

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