title: Endovascular and surgical treatment of spinal dural arteriovenous fistulas.
abstract: BACKGROUND
  The aim of this retrospective study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas (SDAVFs) that were treated with surgery, catheter embolization, or surgery after incomplete embolization.
  
  
  METHODS
  The study included 21 consecutive patients with SDAVFs of the thoracic, lumbar, or sacral spine who were treated in our institution from 1994 to 2007. Thirteen patients were treated with catheter embolization alone. Four patients underwent hemilaminectomy and intradural interruption of the fistula. Four patients were treated by endovascular techniques followed by surgery. The clinical outcome was assessed using the modified Aminoff-Logue scale (ALS) for myelopathy and the modified Rankin scale (MRS) for general quality of life. Patient age ranged from 44 to 77 years (mean 64.7 years).
  
  
  RESULTS
  Surgical as well as endovascular treatment resulted in a significant improvement in ALS (-62.5% and -31.4%, respectively, p < 0.05) and a tendency toward improved MRS (-50% and -32%, respectively) scores. Patients that underwent surgery after endovascular treatment due to incomplete occlusion of the fistula showed only a tendency for improvement in the ALS score (-16.7%), whereas the MRS score was not affected.
  
  
  CONCLUSIONS
  We conclude that both endovascular and surgical treatment of SDAVFs resulted in a good and lasting clinical outcome in the majority of cases. In specific situations, when a secondary neurosurgical approach was required after endovascular treatment to achieve complete occlusion of the SDAVF, the clinical outcome was rather poor. The best first line treatment modality for each individual patient should be determined by an interdisciplinary team.
authors.affiliation: Department of Neurosurgery, University of Berne, Inselspital, Berne, Switzerland. randres@stanford.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Andres
authors.forename: Alain
authors.initials: A
authors.lastname: Barth
authors.forename: Raphael
authors.initials: R
authors.lastname: Guzman
authors.forename: Luca
authors.initials: L
authors.lastname: Remonda
authors.forename: Marwan
authors.initials: M
authors.lastname: El-Koussy
authors.forename: Rolf W
authors.initials: RW
authors.lastname: Seiler
authors.forename: Hans R
authors.initials: HR
authors.lastname: Widmer
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schroth
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply*; D016896:Treatment Outcome