Surgical Treatment of Spinal Dural Arteriovenous Fistulae: A Consecutive Series of 154 Patients

Saladino, Andrea; Atkinson, John L.D.; Rabinstein, Alejandro A.; Piepgras, David G.; Marsh, W. Richard; Krauss, William E.; Kaufmann, Timothy J.; Lanzino, Giuseppe

doi:10.1227/neu.0b013e3181ef2821

Cited by 136 publications

(109 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This result is in line with data from earlier studies [10,14,16,17]. Our surgical success rate of 94.7% was also comparable to previous studies [9,10]. In their meta-analysis of 16 surgical studies, Steinmetz et al [10] found that complete obliteration was achieved in 98% of patients treated with surgery and Saladino et al [9] reported complete surgical obliteration in 146 of 154 patients (94.8%).…”

Section: Treatment Resultssupporting

confidence: 91%

“…Saladino et al [9] reported complications in 5 of 154 operated patient (3.2%). In their meta-analysis, Steinmetz et al [10] found that the complication rate was lower after surgery than embolization (1.9 % vs. 3.7%).…”

Section: Treatment Resultsmentioning

confidence: 97%

“…As surgery is a safe and curative treatment with a low rate of recurrence, it is the gold standard for the management of SDAVF [8][9][10]. While embolization is less invasive, early reports demonstrated a high recurrence rate, especially when polyvinyl alcohol (PVA) was the embolizing agent [11,12].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

et al. 2015

View full text Add to dashboard Cite

Purpose: To examine the validity of our treatment strategy for spinal dural arteriovenous fistulae (SDAVF), based on the treatment results and the long-term outcome.Methods: This study included 50 SDAVF patients (38 men, 12 women, mean age 63.2 years) with progressive myelopathy. The treatment strategy involved embolization as the initial management tool and surgery if embolization was considered unsuitable. Their medical records were evaluated to identify the treatment results and functional outcomes. The mean follow-up period was 81.2 months (range 27 -184 months). Results:Complete obliteration was achieved in 22 (71.0%) of 31 embolized patients and in 18 of 19 (94.7%) operated patients. The initial success rate was significantly lower in embolized-than operated patients. At the last follow-up, 33 of the 50 patients (66%) manifested improved gait and 16 (32%) improved micturition. The activity of daily living (ADL) was improved in 33 (66%).When we compared the rates of functional improvement at the last follow-up, there was no significant difference between patients treated initially by embolization or surgery. Conclusions:The long-term outcomes in SDAVF patients treated by multidisciplinary management with first-line embolization were comparable to those in earlier surgical series. However, our results were unable to demonstrate the superiority of endovascular embolization to surgical treatment for SDAVF. For the purpose of justifying endovascular embolization as a first-line treatment for SDAVF, it will be necessary to show further improvement in both the initial treatment success and the complication rates.(240 words)

show abstract

Section: Treatment Resultssupporting

confidence: 91%

Section: Treatment Resultsmentioning

confidence: 97%

See 1 more Smart Citation

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

et al. 2015

View full text Add to dashboard Cite

show abstract

“…15,26 Lowerextremity weakness is also a frequent initial symptom, usually affecting approximately half of patients, ranging from 32% to 81%. 3,8,9,15,22,24,26,30 By the time of diagnosis or surgery, symptoms have typically progressed, and almost all patients will have lower-extremity weakness. 15,18,20,22,30 Lower-extremity weakness usually involves both legs, but is asymmetrical about half of cases, 6 and even unilateral in up to 16%.…”

Section: Clinical Symptoms and Signsmentioning

confidence: 99%

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

Fugate¹,

Lanzino

Rabinstein³

2012

FOC

Self Cite

View full text Add to dashboard Cite

Spinal dural arteriovenous fistulas (AVFs), the most common type of spinal cord vascular malformation, can be a challenge to diagnose and treat promptly. The disorder is rare, and the presenting clinical symptoms and signs are nonspecific and insidious at onset. Spinal dural AVFs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances. Patients with severe neurological deficits at presentation tend to have worse posttreatment functional outcomes than those with mild or moderate pretreatment disability. However, improvement or stabilization of symptoms is seen in the vast majority of treated patients, and thus treatment is justified even in patients with substantial neurological deficits. The extent of intramedullary spinal cord T2 signal abnormality does not correlate with outcomes and should not be used as a prognostic factor.

show abstract

“…Moreover, the standard microsurgical procedure for SDAVF involves a laminectomy or hemilaminectomy and even partial facetectomy. 14,18 In this present case, we successfully adopted a much less invasive interlaminar approach to treat lumbar SDAVF. Taking advantage of the natural interlaminar space between T-12 and L-1, the dura was opened under microscopic guidance near the middle line (where the interlaminar space was widest) to form an orifice.…”

Section: Discussionmentioning

confidence: 88%

Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

Wang

Chen

Shen

et al. 2016

SPI

View full text Add to dashboard Cite

Spinal dural arteriovenous fistulas (SDAVFs) are the most common type of spinal arteriovenous malformations, and microsurgical ligation is the treatment modality most frequently used for these lesions. Developments in endoscopic techniques have made endoscopy an even less invasive alternative to routine microsurgical approaches in spine surgery, but endoscopic management of SDAVF or other intradural spinal lesions has not been reported to date. The authors describe the use of a microscope-assisted endoscopic interlaminar approach for the ligation of the proximal draining vein of an L-1 SDAVF in a 58-year-old man. A complete cure was confirmed by postoperative angiography. The postoperative course was uneventful, and short-term follow-up showed improvements in the patient's neurological function. The authors conclude that the endoscopic interlaminar approach with microscope assistance is a safe, minimally invasive, innovative technique for the surgical management of SDAVFs in selected patients.

show abstract

Surgical Treatment of Spinal Dural Arteriovenous Fistulae: A Consecutive Series of 154 Patients

Abstract: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.

Cited by 136 publications

References 29 publications

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae

Clinical presentation and prognostic factors of spinal dural arteriovenous fistulas: an overview

Microscope-assisted endoscopic interlaminar ligation of spinal arteriovenous fistulas: technical note

Contact Info

Product

Resources

About