Embolization of spinal dural arteriovenous fistula with polyvinyl alcohol particles: experience in 14 patients.
OBJECTIVE
To assess the effectiveness, initial and long term, of embolization using polyvinyl alcohol particles (PVA) particles in patients with spinal dural arteriovenous fistulas (SDAVF).


METHODS
The initial treatment in 14 patients with SDAVF was embolization with PVA particles. Postembolization occlusion of the SDAVF was documented angiographically in all cases.


RESULTS
All 14 patients initially showed an improvement in clinical symptoms, but the neurologic status of 11 patients subsequently deteriorated. Of the 11 patients who had recurrence of symptoms, nine had angiographically proven recurrences of their SDAVF while two had negative follow-up of spinal angiography. PVA embolization is ineffective for the treatment of SDAVF and is not without risk.


CONCLUSIONS
On the basis of a literature review of the other two alternative treatments (operation or liquid adhesive embolization) available for SDAVF and our preliminary experience with N-butyl cyanoacylate (NBCA) embolization, we suggest that NBCA embolization be the initial treatment of choice for SDAVF; if that procedure is not possible, or is unsuccessful, then operation is recommended.
Nichols
D A
DA
Department of Diagnostic Radiology, Mayo Clinic, Rochester, MN 55905.
Rufenacht
D A
DA
Jack
C R
CR
Forbes
G S
GS
D000368:Aged; D001164:Arteriovenous Fistula / Q000453:epidemiology / Q000628:therapy*; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011142:Polyvinyl Alcohol / Q000627:therapeutic use*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*
D011142:Polyvinyl Alcohol