Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Steinmetz, Michael P.; Chow, Michael; Krishnaney, Ajit A.; Andrews-Hinders, Doreen; Benzel, Edward C.; Masaryk, Thomas J.; Mayberg, Marc R.; Rasmussen, Peter A.

doi:10.1227/01.neu.0000126878.95006.0f

Cited by 282 publications

(210 citation statements)

References 28 publications

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“…This finding may have influenced our results because, even with proper treatment, a long duration of initial neurologic symptoms is associated with poor clinical and functional outcomes. 33 In our study, there was only a 9.1% (n=2/22) failure rate after embolization and a low recurrence rate of 10% of the treated cases (n=2/20), which is an improvement for endovascular treatment compared to the studies described above. Such a rate may be the result of improvements in diagnostic imaging, a better understanding of the pathophysiology of SDAVFs, further developments in microcatheter and microwire technology, or the technical experience of the operators regarding use of liquid embolic agents.…”

Section: Discussioncontrasting

confidence: 42%

“…15 SDAVFs can be treated by surgery with clip placement or coagulation of the vein from a posterior spinal laminectomy approach. 33 Endovascular embolization is an effective therapy in the treatment of SDAVFs and can be used as a definitive intervention in most patients. 30 The success of endovascular treatment is believed to be dependent on complete occlusion of the proximal radicular draining vein and the site of the fistula itself.…”

Section: Introductionmentioning

confidence: 99%

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

Habib¹,

Abdelaal²

2014

Egyptian Spine Journal

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Background Data: Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity. Early diagnosis and effective methods of treatment are badly needed in clinical application. Purpose: To evaluate the clinical and radiological outcome of patients with spinal dural arteriovenous fistulas who were treated with endovascular embolization, with assessment of feasibility, safety and efficacy of endovascular treatment. Study Design: A retrospective clinical case study. Patients and Methods: A retrospective study was conducted on patients with Spinal Dural Arteriovenous Fistulas (SDAVFs) who underwent endovascular treatment in the period between

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Section: Discussioncontrasting

confidence: 42%

Section: Introductionmentioning

confidence: 99%

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

Habib¹,

Abdelaal²

2014

Egyptian Spine Journal

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“…12,30,36,59,63 For reasons yet to be fully determined, there is a preponderance of this diagnosis in males. 12,30,36,59,63 Although a gradual progression in clinical symptoms has been reported in the majority of patients with spinal DAVFs, a more punctuated, stepwise deterioration has been reported in some patients. 32,61 At the time of diagnosis, many patients have already experienced a considerable progression in the severity of symptoms, and approximately half of all patients report motor disturbances, including weakness and gait abnormalities.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…He continued to improve and was almost back to his baseline neurological and ambulatory status at the 6-month follow-up. 59 In addition, intraoperative or postoperative angiography has been frequently used to confirm complete surgical obliteration of spinal DAVFs.…”

Section: Illustrative Casementioning

confidence: 99%

Endovascular management of spinal dural arteriovenous fistulas

Sivakumar

Zada²,

Yashar³

et al. 2009

FOC

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Object Spinal dural arteriovenous fistulas (DAVFs) are the most common spinal vascular malformations and can be a significant cause of myelopathy, yet remain inefficiently diagnosed lesions. Over the last several decades, the treatment of spinal DAVFs has improved tremendously due to improvements in neuroimaging, microsurgical, and endovascular techniques. The aim of this paper was to review the existing literature regarding the clinical characteristics, classification, and endovascular management of spinal DAVFs. Methods A search of the PubMed database from the National Library of Medicine and reference lists of all relevant articles was conducted to identify all studies pertaining to spinal DAVFs, spinal dural fistulas, and spinal vascular malformations, with particular attention to endovascular management and outcomes. Results The ability to definitively treat spinal DAVFs using endovascular embolization has significantly improved over the last several decades. Overall rates of definitive embolization of spinal DAVFs have ranged between 25 and 100%, depending in part on the embolic agent used and the use of variable stiffness microcatheters. The majority of recent studies in which N-butyl cyanoacrylate or other liquid embolic agents were used have reported success rates of 70–90%. Surgical treatment remains the definitive option in cases of failed embolization, repeated recanalization, or lesions not amenable to embolization. Clinical outcomes have been comparable to surgical treatment when the fistula and draining vein remain persistently occluded. Improvements in gait and motor function are more likely following successful treatment, whereas micturition symptoms are less likely to improve. Conclusions Endovascular embolization is an increasingly effective therapy in the treatment of spinal DAVFs, and can be used as a definitive intervention in the majority of patients that undergo modern endovascular intervention. A multidisciplinary approach to the treatment of these lesions is required, as surgery is required for refractory cases or those not amenable to embolization. Newer embolic agents, such as Onyx, hold significant promise for future therapy, yet long-term follow-up studies are required.

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“…Furthermore, after endovascular therapy, patients have to be subjected to repeated angiography and probably embolization [8] as recanalization after successful embolization [1] may occur. For these reasons, surgery is widely considered as first-line therapy for SDAVF and treatment of choice [5,7,8].…”

Section: Introductionmentioning

confidence: 99%

Preoperative coil marking to facilitate intraoperative localization of spinal dural arteriovenous fistulas

et al. 2009

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Considering surgical treatment of spinal dural arteriovenous fistulas, the major difficulty is to localize them reliably during surgery. Usually the affected spinal level is sought by counting of bony structures using fluoroscopy. However, quite frequently, anatomical particularities impede adequate counting resulting in surgery performed at erroneous spinal levels. The objective of this study was therefore to evaluate the potential benefits of preoperative coil marking in order to facilitate intraoperative localization of spinal dural arteriovenous fistulas. After detection of the fistula with spinal angiography, selective catheterization of the feeding vessel was performed, and a GDC coil was detached in the lumen of the vessel adjacent to the respective bony pedicle. Coil marking was effected in 8 patients (group A), 20 patients were operated without such a marking (group B). The data of both groups of patients were compared with regard to accurateness of the surgical approach, duration of surgery, and dosage of intraoperative fluoroscopy. In all patients of group A, the coil was easily identified by intraoperative fluoroscopy. A partial hemilaminectomy was sufficient for localization and microsurgical treatment of the spinal dural arteriovenous fistula in each patient. In patients of group B, the correct spinal level was approached in 12 patients (60%), in 8 patients (40%) surgery was performed initially at an erroneous level (P = 0.048). Mean duration of surgery was 130 min in group A and 177 min in group B (P = 0.031). Likewise, mean dosage of intraoperative fluoroscopy was higher in group B (119.5 vs. 394.3 cGy/cm 2 ; P = 0.036). Preoperative coil marking allows exact intraoperative localization of spinal dural arteriovenous fistulas. Thus, surgery at erroneous spinal levels is avoided, and it is feasible to perform a straightforward, minimally invasive surgical approach. This reflects in significant reduction of duration of anesthesia and surgery. Moreover, radiation exposure of the patient is significantly reduced.

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Outcome after the Treatment of Spinal Dural Arteriovenous Fistulae: A Contemporary Single-institution Series and Meta-analysis

Cited by 282 publications

References 28 publications

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

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

Endovascular management of spinal dural arteriovenous fistulas

Preoperative coil marking to facilitate intraoperative localization of spinal dural arteriovenous fistulas

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