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Endovascular and surgical treatment of spinal dural arteriovenous fistulas

  • Interventional Neuroradiology
  • Published:
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Abstract

Introduction

The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization.

Methods

The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff–Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years).

Results

Surgical as well as endovascular treatment resulted in a significant improvement in ALS (−62.5% and −31.4%, respectively, p < 0.05) and a tendency toward improved MRS (−50% and −32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (−16.7%), whereas the MRS score was not affected.

Conclusion

We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team.

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Conflict of interest statement

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Berne, Inselspital, Berne, Switzerland

    Robert H. Andres, Alain Barth, Raphael Guzman, Rolf W. Seiler & Hans R. Widmer

  2. Department of Diagnostic and Interventional Neuroradiology, University of Berne, Inselspital, Berne, Switzerland

    Robert H. Andres, Luca Remonda, Marwan El-Koussy & Gerhard Schroth

  3. Department of Neurosurgery, Medical University of Graz, Graz, Austria

    Alain Barth

  4. Department of Neurosurgery, Stanford University Medical Center, 1201 Welch Road, MSLS P304, Stanford, CA, 94305-5487, USA

    Robert H. Andres & Raphael Guzman

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  1. Robert H. Andres
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Correspondence to Robert H. Andres.

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Andres, R.H., Barth, A., Guzman, R. et al. Endovascular and surgical treatment of spinal dural arteriovenous fistulas. Neuroradiology 50, 869–876 (2008). https://doi.org/10.1007/s00234-008-0425-3

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