title: Spinal dural arteriovenous fistulas: clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers.
abstract: OBJECTIVE
  Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity with progressive spinal cord symptoms. The aim of this study was to evaluate the clinical outcome of patients with spinal dural arteriovenous fistulas that were primarily treated with endovascular embolization.
  
  
  METHODS
  A retrospective review was performed of all patients from 1997-2010 who underwent treatment at 2 academic referral centers for a spinal dural arteriovenous fistula. Follow-up was performed by clinical examination, and functional status was measured by use of the Aminoff-Logue Disability Scale, McCormick classification grading, and mRS scores. The nonparametric Wilcoxon signed rank test was used to compare pretreatment and posttreatment Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and mRS scores. P values < .05 were considered significant.
  
  
  RESULTS
  A total of 38 patients were included. Five patients (2 endovascular, 3 surgical) were lost to follow-up and therefore were excluded from the analysis, 29 patients were initially treated from an endovascular approach (9 Onyx, 20 cyanoacrylate), and 4 patients were treated from a standard surgical approach. Five patients in the endovascular group subsequently underwent surgery for various reasons. The clinical improvements in the Aminoff-Logue Disability Scale gait and micturition scores, McCormick classification grading, and the mRS scores were statistically significant (P < .05, Wilcoxon signed rank test).
  
  
  CONCLUSIONS
  We conclude that endovascular treatment of spinal dural arteriovenous fistulas can result in good clinical outcomes. Surgery remains the treatment of choice when safe embolization of the proximal radicular draining vein cannot be obtained or because the shunting artery of the spinal dural arteriovenous fistula also supplies the anterior spinal, posterior spinal, or a radiculomedullary artery.
authors.affiliation: Departments of Radiology.
authors.forename: J J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: N
authors.initials: N
authors.lastname: Chaudhary
authors.forename: A E
authors.initials: AE
authors.lastname: Elias
authors.forename: A K
authors.initials: AK
authors.lastname: Toma
authors.forename: A S
authors.initials: AS
authors.lastname: Pandey
authors.forename: R A
authors.initials: RA
authors.lastname: Parker
authors.forename: I
authors.initials: I
authors.lastname: Davagnanam
authors.forename: C O
authors.initials: CO
authors.lastname: Maher
authors.forename: S
authors.initials: S
authors.lastname: Brew
authors.forename: F
authors.initials: F
authors.lastname: Robertson
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D003487:Cyanoacrylates / Q000627:therapeutic use; D004185:Disability Evaluation; D004621:Embolization, Therapeutic / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007796:Laminectomy / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates