title: Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients.
abstract: BACKGROUND
  Spinal dural arteriovenous fistula (SDAVF) is a rare spinal vascular malformation with an annual incidence of 5-10 cases per million. The data on efficacy, recurrence rates and complications of endovascular versus surgical treatment of SDAVF is limited.
  
  
  METHODS
  We conducted a retrospective chart review of 27 adult patients with a diagnosis of SDAVF and who underwent treatment at Duke University Hospital between January 1, 1993 and December 31, 2012. We compared the outcome measures by Aminoff-Logue score (ALS) in patients who underwent treatment with endovascular embolization versus surgical ligation of fistula. We compared complication rates, recurrence rates as well as data on long-term follow up in these patients.
  
  
  RESULTS
  Out of 27 patients in the study, 10 patients underwent endovascular embolization (Onyx was used in 5 patients and NBCA in 5 patients) as the first line therapy. Seventeen patients underwent surgical ligation as initial therapeutic modality. Patients in both groups showed significant improvement in clinical status (ALS) after treatment. One patient in endovascular group developed spinal infarction due to accidental embolization of medullary artery. Three patients in embolization group had recurrence of fistula during the course of follow up requiring surgical ligation. Two patients in surgical group developed local wound infection. None of the patients in surgical group had recurrence of fistula during the course of follow up.
  
  
  CONCLUSIONS
  Endovascular embolization and surgical ligation are effective treatment strategies for SDAVF. Our observations show that surgical ligation may offer permanent cure without any recurrence. Endovascular approach is associated with higher incidence of recurrence, especially with use of onyx.
authors.affiliation: Division of Neurocritical Care, Department of Neurology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Sankalp
authors.initials: S
authors.lastname: Gokhale
authors.affiliation: Division of Neuro-anesthesia, Department of Anesthesiology, Duke University Hospital, Duke University School of Medicine, Durham, NC 27710, USA.
authors.forename: Shariq A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Department of Anesthesiology and Neurology, Chief, Division of Neuro-anesthesiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: McDonagh
authors.affiliation: Department of Neurosurgery, Methodist Hospital of Houston, University of Texas -Houston, 6560 Fannin St. Suite 944, Houston, TX 77030, USA.
authors.forename: Gavin
authors.initials: G
authors.lastname: Britz
keywords: Aminoff–Logue scale; embolization; recurrence; spinal dural AV fistula; surgery