title: Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapeutic modality.
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of endovascular therapy as a primary treatment for spinal dural arteriovenous fistula (DAVF).
  
  
  METHODS
  The authors reviewed 18 patients with spinal DAVFs for whom endovascular therapy was considered as an initial treatment at a single institute between 1993 and 2006. NBCA embolization was considered the primary treatment of choice, with surgery reserved for patients in whom endovascular treatment failed.
  
  
  RESULTS
  Surgery was performed as the primary treatment in one patient because the anterior spinal artery originated from the same arterial pedicle as the artery feeding the fistula. Embolization was used as the primary treatment modality in 17 patients, with an initial success rate of 82.4%. Two patients with incomplete embolization had to undergo surgery. One patient underwent multiple embolizations, which failed to completely occlude the fistula but relieved the patient's symptoms. Spinal DAVF recurred in two patients (one collateral development and one recanalization) during the follow-up period. The collateral development was obliterated by repeated embolization, but the patient with recanalization refused further treatment. The overall clinical status improved in 15 patients (83.3%) during the follow-up period.
  
  
  CONCLUSIONS
  Endovascular therapy can be successfully used as a primary treatment for the majority of patients with spinal DAVFs. Although it is difficult to perform in some patients, endovascular embolization should be the primary treatment of choice for spinal DAVF.
authors.affiliation: Department of Neurosurgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Korea.
authors.forename: Sung Bae
authors.initials: SB
authors.lastname: Park
authors.forename: Moon Hee
authors.initials: MH
authors.lastname: Han
authors.forename: Tae-Ahn
authors.initials: TA
authors.lastname: Jahng
authors.forename: Bae Ju
authors.initials: BJ
authors.lastname: Kwon
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung