A single-center, long-term study of spinal dural arteriovenous fistulas with multidisciplinary treatment

Ruiz‐Juretschke, Fernando; Pérez-Calvo, J.M.; Castro, Enrique; García-Leal, Roberto; Sierra, Olga Mateo; Fortea, Fernando; Iza, B.; Garbizu, J.M.; Villoria, Francisco

doi:10.1016/j.jocn.2011.03.008

Cited by 35 publications

(13 citation statements)

References 29 publications

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“…Furthermore, endovascular therapy may be contraindicated if the radicular artery is in fact a radiculomedullary artery supplying the ASA. 29 In contrast, microsurgery allows for direct visualization of the fistula point and safe ligation without reliance on the morphology of access vessels and their contributions to the ASA.…”

Section: Saladino and Colleaguesmentioning

confidence: 99%

Surgical treatment of Type I spinal dural arteriovenous fistulas

Ropper

Gross²,

Du³

2012

FOC

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Object Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration. Methods The authors reviewed their experience in treating 214 craniospinal arteriovenous malformations and/or fistulas over the last 8 years. Of these, 19 were spinal (9%), of which 15 (79%) were Type I SDAVFs. The authors reviewed the patients' epidemiological characteristics, presenting symptoms, and SDAVF angioarchitecture in all cases. They subsequently analyzed surgical obliteration rates and outcomes of all 11 patients who underwent fistula microsurgical obliteration. Results In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. At follow-up, 10 (91%) of 11 patients exhibited improvement, 1 patient (9%) was the same, and no patients were worse. Specifically, 8 (73%) of 11 patients had improvement in strength and sensation, 5 (71%) of 7 had improvement of bowel/bladder function, and 3 (60%) of 5 had improvement of preoperative paresthesias. There were no wound infections, CSF leaks, or permanent neurological deficits. Conclusions Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications.

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Section: Saladino and Colleaguesmentioning

confidence: 99%

Surgical treatment of Type I spinal dural arteriovenous fistulas

Ropper

Gross²,

Du³

2012

FOC

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“…The optimal management of SDAVF by initial surgery or embolization remains controversial and a multidisciplinary approach has been suggested [7,16,[18][19][20]. It involves embolization as the initial management tool and surgery if embolization fails or is considered difficult and/or unsafe.…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

et al. 2015

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Purpose: To examine the validity of our treatment strategy for spinal dural arteriovenous fistulae (SDAVF), based on the treatment results and the long-term outcome.Methods: This study included 50 SDAVF patients (38 men, 12 women, mean age 63.2 years) with progressive myelopathy. The treatment strategy involved embolization as the initial management tool and surgery if embolization was considered unsuitable. Their medical records were evaluated to identify the treatment results and functional outcomes. The mean follow-up period was 81.2 months (range 27 -184 months). Results:Complete obliteration was achieved in 22 (71.0%) of 31 embolized patients and in 18 of 19 (94.7%) operated patients. The initial success rate was significantly lower in embolized-than operated patients. At the last follow-up, 33 of the 50 patients (66%) manifested improved gait and 16 (32%) improved micturition. The activity of daily living (ADL) was improved in 33 (66%).When we compared the rates of functional improvement at the last follow-up, there was no significant difference between patients treated initially by embolization or surgery. Conclusions:The long-term outcomes in SDAVF patients treated by multidisciplinary management with first-line embolization were comparable to those in earlier surgical series. However, our results were unable to demonstrate the superiority of endovascular embolization to surgical treatment for SDAVF. For the purpose of justifying endovascular embolization as a first-line treatment for SDAVF, it will be necessary to show further improvement in both the initial treatment success and the complication rates.(240 words)

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“…Спинальные дуральные артериовенозные фистулы -наиболее частая (до 80%) сосудистая патология спинного мозга [15,16]. Трудности диагностики и неспецифическая клиническая картина приводят к поздней постановке диагноза и недооценке числа больных с данной патологией [8,[17][18][19].…”

Section: Discussionunclassified

“…В остальных случаях от начала заболевания до постановки диагноза проходило не менее нескольких месяцев. Максимальное время составило 240 мес [16]. Медиана длительности симптомов от момента заболевания до постановки диагноза составила 13 мес (Me=13 мес, Q1=7 и Q3=36).…”

Section: выраженность и длительность симптомовunclassified

Spinal dural arteriovenous fistulas. A series of clinical cases and an analysis of the literature data

et al. 2017

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Спинальные дуральные артериовенозные фистулы (спДАВФ)-наиболее частая сосудистая патология спинного мозга, обусловливающая сегментарное поражение спинного мозга за счет венозной ишемии. Функциональные исходы лечения пациентов с спДАВФ благоприятны, но вероятность улучшения варьирует от 25 до 100%, и такой диапазон затрудняет прогнозирование исхода. Цель исследования-выявить взаимосвязь между локализацией фистулы и клиническими ее проявлениями, оценить влияние длительности заболевания, степени неврологических нарушений на непосредственные и отдаленные результаты лечения на основании анализа публикаций и собственных данных. Материал и методы. В сентябре 2016 г. осуществлен поиск публикаций в базе данных PubMed по ключевым словам «spinal arteriovenous fistula», «treatment», «outcome». Отобраны публикации, содержащие информацию о возрасте пациента, локализации фистулы, длительности заболевания и оценке выраженности симптоматики по Aminoff-Logue scale до и после операции, а также не менее чем через 3 мес после вмешательства. В анализ, кроме того, включены данные о пациентах, оперированных в нашей клинике. В общей сложности анализ охватил 187 пациентов. Результаты. Наиболее частая локализация фистулы соответствовала уровню ThVI, ThVII и ThIX позвонков, бóльшая выраженность двигательных нарушений наблюдалась при локализации фистулы на уровне или ниже ThIX позвонка. Хирургическое разобщение фистулы приводит к улучшению функционального состояния больных, при этом пациенты в возрасте до 60 лет имеют лучшие шансы на восстановление нарушенных функций. Двигательные нарушения значимо регрессируют в раннем послеоперационном периоде у всех пациентов, но в отдаленном периоде наблюдается нарастание двигательных расстройств у пациентов с исходно лучшим функциональным состоянием.

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A single-center, long-term study of spinal dural arteriovenous fistulas with multidisciplinary treatment

Cited by 35 publications

References 29 publications

Surgical treatment of Type I spinal dural arteriovenous fistulas

Surgical treatment of Type I spinal dural arteriovenous fistulas

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

Spinal dural arteriovenous fistulas. A series of clinical cases and an analysis of the literature data

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