title: Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients.
abstract: OBJECTIVE
  In the early 1980s, it was demonstrated that surgical intradural division of the shunting vein to the medullary venous plexus cures a spinal dural arteriovenous fistula (DAVF) at low morbidity. There is, however, growing literature to support endovascular therapy.
  
  
  METHODS
  The clinical features of 49 consecutive patients with a spinal DAVF treated at a single institution between 1986 and 2001 were studied (mean age, 63 years; range, 28 to 78 years; 80% male). When possible, embolization was offered as the initial treatment. Endovascular treatment was considered adequate only if the proximal shunting vein could be occluded with liquid adhesive embolics. Motor and bladder function was evaluated with Aminoff scores an average of 32.3 months after treatment.
  
  
  RESULTS
  All but 1 patient presented with myelopathy. At a mean of 2.3 years after symptom onset, 48 DAVFs were angiographically demonstrated. Since 1999, gadolinium-enhanced MR angiography was additionally performed in 7 patients to point out the level of the DAVF. Endovascular embolization could be attempted in 44 of the 48 DAVFs and resulted in a cure in 11 (25%). Thirty-five DAVFs were surgically cured; 2 patients refused surgery after failed embolization. Angiographic confirmation of the treatment result was available in 97.7% of the patients. No permanent complications of either embolization or surgery were noted. Motor and bladder function scores were significantly improved in 35 patients who had long-term follow-up (both P<0.005).
  
  
  CONCLUSIONS
  Endovascular treatment with liquid adhesive material provided a result equal to surgery in 25% of patients, overall resulting in a significant amelioration in the neurological status of patients with a spinal DAVF.
authors.affiliation: Brain Vascular Malformation Study Group, University of Toronto, Toronto Western Hospital, Division of Neurosurgery, Ontario, Canada. vandijk.md@planet.nl.
authors.forename: J Marc C
authors.initials: JM
authors.lastname: Van Dijk
authors.forename: Karel G
authors.initials: KG
authors.lastname: TerBrugge
authors.forename: Robert A
authors.initials: RA
authors.lastname: Willinsky
authors.forename: Richard I
authors.initials: RI
authors.lastname: Farb
authors.forename: M Christopher
authors.initials: MC
authors.lastname: Wallace
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D019468:Disease Management; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D020335:Paraparesis / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000209:etiology; D013122:Spinal Diseases / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D013995:Time; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000209:etiology; D014656:Vascular Surgical Procedures