Validation of an ‘endovascular-first’ approach to spinal dural arteriovenous fistulas: an intention-to-treat analysis

Gross, Bradley A.; Albuquerque, Felipe C; Moon, Karam; McDougall, Cameron G.

doi:10.1136/neurintsurg-2016-012333

Cited by 25 publications

(10 citation statements)

References 11 publications

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“…Several treatment modalities have been described for intramedullary AVMs including microsurgical resection, 43 endovascular embolization, 44 and radiation treatment, 45 as well as a combination of these procedures. With respect to the different outcomes reported with these treatments, the gold standard of treatment is debatable, with some authors reporting successful outcomes using endovascular treatment alone, and others reporting the need for microsurgical resection as a first‐line treatment or after endovascular treatment, depending on the size of the lesion 45‐47 . In cases where lesions are large in size, involve the ventral half of the spinal cord, or involve multiple feeding vessels from the anterior spinal artery, definitive treatment is not feasible without substantial neurological dysfunction and iatrogenic disability postoperatively 43,44,48 …”

Section: Discussionmentioning

confidence: 99%

Myelopathy secondary to an intramedullary arteriovenous malformation in a mature dog

Freitas¹,

Housley²,

Caine³

et al. 2021

Veterinary Internal Medicne

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A 2-year-old crossbreed dog was presented for evaluation of a 6-week history of progressive paraparesis. Magnetic resonance imaging and computed tomography angiography of the thoracic and lumbar spinal cord disclosed multifocal, anomalous, small, vascular structures, distributed throughout the subarachnoid space of the included section of the spinal cord. An additional focal intramedullary lesion was identified extending from T9 to T10 to T12. Histopathological examination confirmed the presence of an intramedullary arteriovenous malformation affecting the thoracic spinal cord and leading to diffuse congestion and focal hemorrhages into the affected spinal cord.

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Section: Discussionmentioning

confidence: 99%

Myelopathy secondary to an intramedullary arteriovenous malformation in a mature dog

Freitas¹,

Housley²,

Caine³

et al. 2021

Veterinary Internal Medicne

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“…3 Studies demonstrate that there are no differences in the obliteration rates between the endovascular and microsurgical treatments, enabling the migration from embolization to surgery, either due to the impossibility of embolization, or due to inadequate occlusion. 7 Some services suggest that the initial attempt of embolization at the moment of the diagnostic arteriography is feasible; however, it has failure rates of 50%, 4,7 unlike the surgical treatment, which is definitive in all cases. 4 For proper embolization, it should be possible to navigate with the microcatheter to the fistulous point where the liquid emboligenic agent is injected, 3 which is not always possible, as in the present case.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Intradural Spinal Arteriovenous Fistula: Technical Case Report

2017

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Introduction Although rare, arteriovenous fistula (AVF) is the most common vascular malformation of the spine, and it is mainly located in the thoracic region. The fistula is identified by arteriography, which enables the treatment by embolization or guides the microsurgical therapy. Clinical Presentation We describe the case of a 61-year-old woman with neurogenic claudication evolving to paraparesis. A dorsal intradural AVF was identified by magnetic resonance imaging (MRI) and arteriography, and it was submitted to an embolization, but the procedure was unsuccessful. The patient was then referred for neurosurgery, and the AVF was obliterated using a microsurgical technique guided by multimodal intraoperative monitoring. We identified the AVF in the intraoperative moment and we then cut and coagulated the extradural portion of the nerve root. Discussion Arteriovenous fistulas occur in the dura mater of the nerve roots with the arterialization of the venous plexus. The treatment prevents the progression of the deficits. While performing diagnostic arteriography, attempts of embolization are possible. Conclusion Although the initial attempt of embolization at the moment of the diagnostic arteriography is achievable, it has failure rates of 50%, unlike the surgical treatment, which is definitive in all cases, as reported in this article.

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“…If there is no complete obliteration of the fistula, usually the patient is addressed for a microsurgical approach as soon as possible. Also, if there are doubts concerning the complete occlusion of the proximal radiculomedullary draining vein, a control angiographies are performed at one, three and six months later 2,9,12 . Complications: The complications that results from open surgical ligation or resection are; meningitis, cerebrospinal fluid leak, and wound dehiscence.…”

Section: Fig3 Savf: the Connection Between Radicular Artery And The mentioning

confidence: 99%

Management of Spinal Dural Arteriovenous Fistula, a Review With One Case Report

A¹,

A²,

A³

et al. 2018

Basrah Journal of Surgery

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Spinal dural arteriovenous fistulas (SDAVFs) are rare acquired vascular malformations of the spinal cord which if not treated properly, can lead to inevitable severe morbidity with progressive spinal cord symptoms. The management is still at high interest among specialists. If microsurgical treatment is still considered as a treatment of choice for SDAVFs, endovascular treatment is increasingly growing in interest with the development of endovascular techniques and new embolization materials. In this article, a short discussion is made about the spinal dural arteriovenous fistulae in respect to anatomy, etiology, diagnosis and treatment. Careful patient selection, a multidisciplinary approach and standardized surgical techniques can lead to excellent results with virtually no complications.

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Validation of an ‘endovascular-first’ approach to spinal dural arteriovenous fistulas: an intention-to-treat analysis

Abstract: Our results support attempted embolization of SDAVFs prior to consideration of microsurgery, allowing for a less invasive treatment option in the same session as diagnostic angiography.

Cited by 25 publications

References 11 publications

Myelopathy secondary to an intramedullary arteriovenous malformation in a mature dog

Myelopathy secondary to an intramedullary arteriovenous malformation in a mature dog

Treatment of Intradural Spinal Arteriovenous Fistula: Technical Case Report

Management of Spinal Dural Arteriovenous Fistula, a Review With One Case Report

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