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

Gokhale S, Khan SA, McDonagh DL, Britz G - Surg Neurol Int (2014)

Bottom Line: Patients in both groups showed significant improvement in clinical status (ALS) after treatment.Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF.Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA.

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.

No MeSH data available.


Related in: MedlinePlus

Spinal AV Dural fistula in one of the study subjects. (a) Spinal arteriogram shows a vascular nidus (vertical arrow), and a tortuous draining vein (arrowhead), after contrast injection through a microcatheter (horizontal arrow) at T-7 level on left side. (b) T2-weighted imaging on MRI scan of the same subject shows cord signal change and edema at midthoracic level (Green arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3927093&req=5

Figure 1: Spinal AV Dural fistula in one of the study subjects. (a) Spinal arteriogram shows a vascular nidus (vertical arrow), and a tortuous draining vein (arrowhead), after contrast injection through a microcatheter (horizontal arrow) at T-7 level on left side. (b) T2-weighted imaging on MRI scan of the same subject shows cord signal change and edema at midthoracic level (Green arrows)

Mentions: Vascular malformations of spinal cord are rare clinical entities.[6815] Traditionally, they are classified into three categories depending upon the arterial supply and anatomic characteristics.[7] Spinal dural arteriovenous fistula (SDAVF) constitutes 70–80% of all spinal vascular malformations with an annual incidence of 5-10 cases per million.[1] The vascular nidus is located on the dural sheath of a spinal nerve root and is supplied by a dural artery, usually a branch of radicular or intercostal artery[3] [Figure 1]. Intradural arteriovenous malformations (AVMs) and cavernous angiomas are less common types of vascular malformations of spinal cord.


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

Gokhale S, Khan SA, McDonagh DL, Britz G - Surg Neurol Int (2014)

Spinal AV Dural fistula in one of the study subjects. (a) Spinal arteriogram shows a vascular nidus (vertical arrow), and a tortuous draining vein (arrowhead), after contrast injection through a microcatheter (horizontal arrow) at T-7 level on left side. (b) T2-weighted imaging on MRI scan of the same subject shows cord signal change and edema at midthoracic level (Green arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3927093&req=5

Figure 1: Spinal AV Dural fistula in one of the study subjects. (a) Spinal arteriogram shows a vascular nidus (vertical arrow), and a tortuous draining vein (arrowhead), after contrast injection through a microcatheter (horizontal arrow) at T-7 level on left side. (b) T2-weighted imaging on MRI scan of the same subject shows cord signal change and edema at midthoracic level (Green arrows)
Mentions: Vascular malformations of spinal cord are rare clinical entities.[6815] Traditionally, they are classified into three categories depending upon the arterial supply and anatomic characteristics.[7] Spinal dural arteriovenous fistula (SDAVF) constitutes 70–80% of all spinal vascular malformations with an annual incidence of 5-10 cases per million.[1] The vascular nidus is located on the dural sheath of a spinal nerve root and is supplied by a dural artery, usually a branch of radicular or intercostal artery[3] [Figure 1]. Intradural arteriovenous malformations (AVMs) and cavernous angiomas are less common types of vascular malformations of spinal cord.

Bottom Line: Patients in both groups showed significant improvement in clinical status (ALS) after treatment.Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF.Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA.

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.

No MeSH data available.


Related in: MedlinePlus