title: Surgical management of spinal dural arteriovenous fistulas.
abstract: Spinal dural arteriovenous fistulas are the most common type of spinal arteriovenous malformations. Treatment options consist of microsurgical exclusion and/or endovascular embolization. We retrospectively identified all patients who benefited from surgical treatment at our tertiary center between January 2001 and December 2008. Clinical and imaging data were collected from patient files, including pre- and post-operative formal neurological examination, complete spine MRI and spinal digital subtraction angiography. Of our 30 patients, 25 were men and five were women with a median age of 62 years (range 24-76). The average delay between symptom onset and clinical diagnosis was 27 months (range 1-90). Complete cure of the fistula was obtained in all patients in a single surgical session with no procedural complications and no surgical morbidity. After a mean follow-up period of 32 months (range 14-128), 25 patients (83%) had improved, four were stable and one worsened. Despite recent advances in endovascular techniques and materials, there is a subgroup of patients for which surgery remains the best treatment option. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications.
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France; Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Chibbaro
authors.affiliation: Interventional Neuroradiology, Lariboisière University Hospital, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Gory
authors.affiliation: Tucson Neurological Center, Tucson, AZ, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Marsella
authors.affiliation: Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Tigan
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Herbrecht
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France.
authors.forename: Mikael
authors.initials: M
authors.lastname: Orabi
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Bresson
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France.
authors.forename: Fabian
authors.initials: F
authors.lastname: Baumann
authors.affiliation: Interventional Neuroradiology, Lariboisière University Hospital, Paris, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Saint-Maurice
authors.affiliation: Department of Neurosurgery, Lariboisière University Hospital, Paris, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: George
authors.affiliation: Department of Neurosurgery, Hautepierre University Hospital, Strasbourg, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Kehrli
authors.affiliation: Interventional Neuroradiology, Lariboisière University Hospital, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Houdart
authors.affiliation: Interventional Neuroradiology, Hautepierre University Hospital, 1 Avenue Moliere, 67098 Strasbourg, France.
authors.forename: Monica
authors.initials: M
authors.lastname: Manisor
authors.affiliation: Interventional Neuroradiology, Hautepierre University Hospital, 1 Avenue Moliere, 67098 Strasbourg, France. Electronic address: pop.raoul@gmail.com.
authors.forename: Raoul
authors.initials: R
authors.lastname: Pop
mesh_terms: D000328:Adult; D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000150:complications / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D020233:Gait Disorders, Neurologic / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014555:Urination Disorders / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Spinal dural arteriovenous fistulas; Spinal vascular malformations; Spine