Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients

Abstract

Background:Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited.Methods:We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff–Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients.Results:Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up.Conclusions:Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.

Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement ofStaphylococcus aureus

“…We identified 10 studies evaluating re-admission rates caused by SSIs developing after spine operations of interest [52,64,69,90,118,124,156,177–179]. Based on four studies with a total of 135 procedures that developed SSIs, the 30-day SSI-related re-admission rate ranged from 20% to 100% [52,69,124,156].…”

A Patient with Spinal Epidural Arteriovenous Fistula Cured by Balloon-assisted Transarterial Embolization under Flow Control

“…For SDAVF, the rate of cure by surgical treatment is high compared with the rate by endovascular treatment, but invasiveness of laminectomy and complication by infection are disadvantageous. [7][8][9] Opportunities to perform endovascular treatment as the first-line treatment have been increasing, 10) and this tendency may be accelerated with the improvement of treatment techniques and advances of devices. There is no doubt that endovascular treatment will become the main stream of treatment also for SEDAVF.…”

Intraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact

“…As another alternative to spinal IODSA, some authors recommend performing postoperative spinal angiography 24–72 hours after the surgical procedure 18 19 24. However, by identifying a residual lesion or other potential complication when the patient is still in the operating room, before surgical closure, IODSA authorizes immediate adjustments, preventing the burden of re-operation and of additional invasive diagnostic procedures in the immediate postoperative period.…”