Multidisciplinary Management of Spinal Dural Arteriovenous Fistulas

Abstract

Background and Purpose-In the early 1980s, it was demonstrated that surgical intradural division of the shunting vein to the medullary venous plexus cures a spinal dural arteriovenous fistula (DAVF) at low morbidity. There is, however, growing literature to support endovascular therapy.

Spinal Dural Arteriovenous Fistulas: Clinical and Radiological outcome of Endovascular Treatment

“…10 Van Dijk et al, 37 reported a cure rate of only 25% (11/44 patients) after treatment with n-BCA embolization. After failed endovascular treatment, 31 patients were cured surgically; the 2 other patients refused surgery.…”

“…18 Bowel and bladder incontinence, erectile dysfunction, and urinary retention are seen late in the course of the disease process. 37 If the lesion is not treated, 50% of patients will become severely disabled and less than 10% will be able to walk independently after 3 years. 9 Favorable outcome depends on the progression of neurologic deficits at the time of diagnosis, which makes early diagnosis preferable.…”

Foix-Alajouanine syndrome: case report

“…Despite its high sensibility, arteriography may be inconclus i v e . van Dijk et al 7 described two patients whose angiograms did not reveal a spinal AV fistula, although the patients had classic signs and symptoms, both clinically and on MRI. Criscuolo et al 6 described two patients with diagnosis of Foix-Alajouanine syndrome and a negative spinal art e r i o g r a p h y.…”

Spinal Dural Arteriovenous Fistulas Supplied from Multiple Segmental Arteries: Microsurgery Using Indocyanine Green Angiography and Radiosurgery with a Spine Tracking System

“…In Group 1, symptoms develop slowly due to compression of the spinal cord and/or nerve roots by enlarged epidural venous pouches [1]. Treatment with endovascular occlusion and/or surgical disconnection of fistulas is required in patients with acute or rapidly progressive symptoms before the spinal cord damage becomes irreversible [2][3][4]. Benign fistulas are a developing indication for radiosurgery [5].…”

“…A cure rate of 25-77% for endovascular embolization using liquid adhesive materials for classic type d-AVs has been reported [2,7], and rapid improvements in symptoms are obtained after endovascular treatment [4]. However, it is difficult to treat d-AVFs supplied from multiple segmental arteries or the same pedicle to the anterior spinal artery using endovascular intervention.…”