Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment.
BACKGROUND
The optimal treatment of spinal dural arteriovenous fistulae (SDAVF) remains controversial and long-term follow-up data, especially data from multidisciplinary treatment, are rarely available. Thus, long-term outcomes following a multidisciplinary approach to the treatment of SDAVF were investigated.


METHODS
The investigation included 26 patients with SDAVF treated at the authors' department over a 15-year period including a follow-up of more than 2 years. The treatment strategy when occlusion of the draining vein could be achieved was to embolize the fistula with Histoacryl, with surgery reserved for those patients unsuitable for embolization. Posttreatment angiography followed by MRI was performed in all patients. Clinical follow-up was performed using the gait and micturition Aminoff-Logue scale scores and the modified Rankin scale score.


RESULTS
Embolization was performed in 19 patients (73.1%), and direct surgery in 7 patients (26.9%). Follow-up angiography (at a mean of 21.7 months) showed occlusion of the SDAVF in 24 patients (92.3%). Of the 19 embolized patients, 2 (10.5%) developed recurrence secondary to insufficient occlusion of the SDAVF draining vein, and one of these two patients underwent re-embolization and one re-operation. No negative effects of SDAVF recurrence on the final clinical outcome were identified in either patient. MRI after angiography (at a mean of 91.5 months) demonstrated occlusion of all SDAVFs. After a mean clinical follow-up of 103.4 months there was a statistically significant improvement in both the modified Rankin scale score and the Aminoff-Logue gait scale score (P < 0.05).


CONCLUSIONS
The present multidisciplinary study showed for the first time that embolization leads to stable neuroradiological results and favourable clinical outcomes even for very long follow-up times of more than 100 months. Microsurgery remains the treatment of choice when safe embolization of the draining vein cannot be achieved.
Sherif
Camillo
C
Department of Neurosurgery, Medical University Vienna, Vienna, Austria. camillo.sherif@meduniwien.ac.at
Gruber
Andreas
A
Bavinzski
Gerhard
G
Standhardt
Harald
H
Widhalm
Georg
G
Gibson
Daniel
D
Richling
Bernd
B
Knosp
Engelbert
E
D000203:Activities of Daily Living / Q000145:classification; D000328:Adult; D000368:Aged; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D004659:Enbucrilate / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009460:Neurologic Examination; D010348:Patient Care Team; D012008:Recurrence; D019233:Retreatment; D014014:Tissue Adhesives / Q000627:therapeutic use
D014014:Tissue Adhesives; D004659:Enbucrilate