N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae.
OBJECTIVE
Because they are not well established, we investigated the technical success and recurrence rates of n-butyl 2-cyanoacrylate (NBCA) embolization of spinal dural arteriovenous fistulae (SDAVF), and assessed clinical outcomes.


METHODS
We retrospectively studied all patients with SDAVF treated by NBCA embolization at our institution over an 8-year period. Gait and micturition disabilities were analyzed. Follow-up periods averaged 3.1 years (range, 1 month to 8.9 years).


RESULTS
NBCA embolization was feasible in 74% (20/27) of patients. Of 20 patients who underwent embolization, initial embolization failure occurred in two (10%) and fistula occurrence in three (15%). All five patients in whom NBCA embolization failed underwent surgery. All patients who underwent embolization had either improved (55%) or unchanged (45%) gait disability at last follow-up. Seventeen (85%) patients had improved (40%) or unchanged (45%) micturition disability, but three (15%) had worsened. Mean Aminoff gait disability grade significantly decreased at last follow-up (2.4 [1.4] average [SD] vs 3.2 [1.4] [P = .0008]). Mean micturition disability grade decreased, but not significantly (1.4 [1.0] vs 1.7 [1.1] [P = .28]).


CONCLUSIONS
NBCA embolization of SDAVF was technically feasible in 75% of patients. Initial apparent successful embolization was achieved in 90%; the fistula recurrence rate (failure to occlude the draining vein) for NBCA was 15%. Comparing favorably to surgical series, NBCA embolization of SDAVF appears efficacious, significantly improving mean gait disability by almost one grade at last follow-up. Close clinical and angiographic surveillance is mandatory. Longer and more uniform follow-up is needed to determine if clinical improvement and stabilization after NBCA embolization are sustained.
Song
J K
JK
Department of Radiology, University of California at Los Angeles School of Medicine, 90095-1721, USA.
Gobin
Y P
YP
Duckwiler
G R
GR
Murayama
Y
Y
Frazee
J G
JG
Martin
N A
NA
Viñuela
F
F
D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000628:therapy*; D004185:Disability Evaluation; D004388:Dura Mater / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods*; D004659:Enbucrilate / Q000031:analogs & derivatives / Q000627:therapeutic use*; D005260:Female; D005684:Gait; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D016896:Treatment Outcome; D014554:Urination
D004659:Enbucrilate