Endovascular and surgical treatment of spinal dural arteriovenous fistulas

Andres, Robert H; Barth, Alain; Guzman, Raphael; Remonda, Luca; El-Koussy, Marwan; Seiler, Rolf W; Widmer, Hans R; Schroth, Gerhard (2008). Endovascular and surgical treatment of spinal dural arteriovenous fistulas. Neuroradiology, 50(10), pp. 869-876. Berlin: Springer-Verlag 10.1007/s00234-008-0425-3

[img]
Preview
Text
234_2008_Article_425.pdf - Published Version
Available under License Publisher holds Copyright.

Download (242kB) | Preview

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurosurgery
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Andres, Robert; Remonda, Luca; El-Koussy, Marwan; Seiler, Rolf; Widmer, Hans Rudolf and Schroth, Gerhard

ISSN:

0028-3940

ISBN:

18587568

Publisher:

Springer-Verlag

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:00

Last Modified:

26 Jun 2018 14:06

Publisher DOI:

10.1007/s00234-008-0425-3

PubMed ID:

18587568

Web of Science ID:

000259576300007

BORIS DOI:

10.7892/boris.26103

URI:

https://boris.unibe.ch/id/eprint/26103 (FactScience: 65639)

Actions (login required)

Edit item Edit item
Provide Feedback