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Cent Eur Neurosurg 2010; 71(1): 8-12
DOI: 10.1055/s-0029-1224195
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Clues In Spinal Dural Arteriovenous Fistulas – A 30 Year Experience Of 156 Cases

C. Hessler1 [*] , J. Regelsberger1 [*] , U. Grzyska2 , T. Illies2 , H. Zeumer2 , M. Westphal1
  • 1University Hospital Hamburg-Eppendorf, Neurosurgery, Hamburg, Germany
  • 2University Hospital Hamburg-Eppendorf, Neuroradiology, Hamburg, Germany
Further Information

Publication History

Publication Date:
25 September 2009 (online)

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Background: Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach.

Material and Methods: From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique.

Results: 156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means.

Conclusion: Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.

Key words

spinal vascular malformation - dural arteriovenous fistula - therapeutic findings

References

  • 1 Andres RH, Barth A, Guzman R. et al . Endovascular and surgical treatment of spinal dural arteriovenous fistulas.  Neuroradiology. 2008;  50 869-876
    Google Scholar
  • 2 Anson JA, Spetzler RF. Classification of spinal arterio-venous malformations and implications for treatment.  Barrow Neurol Inst Q. 1992;  8 2-8
    Google Scholar
  • 3 Aoyama T, Hida K, Yano S. et al . Rare intramedullary tandem lesions on MRI due to spinal arteriovenous fistula.  Neurology. 2008;  71 1198-1199
    Google Scholar
  • 4 Atkinson JL, Miller GM, Krauss WE. et al . Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy.  Mayo Clin Proc. 2001;  76 1120-1130
    Google Scholar
  • 5 Behrens S, Thron A. Long-term follow-up and outcome in patients treated for spinal dural arteiovenous fistula.  J Neurol. 1999;  246 181-185
    Google Scholar
  • 6 Blehaut V, Drouet A, Tahon F. et al . Spinal dural arteriovenous fistula with peri-medullary venous drainage: analysis of a series from a single centre and review of the literature.  Rev Neurol (Paris). 2006;  162 1091-1108
    Google Scholar
  • 7 Britz GW, Lazar D, Eskridge J. et al . Accurate intraoperative localization of spinal dural arteriovenous fistulae with embolization coil: technical note.  Neurosurgery. 2004;  55 ((1)) 252-254 , discussion 2004; 254–255
    Google Scholar
  • 8 Cecchi PC, Musumeci A, Faccioli F. et al . Surgical treatment of spinal dural arterio-venous fistulae: long-term results and analysis of prognostic factors.  Acta Neurochir (Wien). 2008;  150 563-570
    Google Scholar
  • 9 Choi IS, Berenstein A. Surgical neuroangiography of the spine and the spinal cord.  Radiol Clin North Am. 1988;  26 1131-1141
    Google Scholar
  • 10 Eskandar EN, Borges LF, Budzik Jr RF. et al . Spinal dural arteriovenous fistulas: experience with endovascular and surgical therapy.  J Neurosurg. 2002;  96 ((Suppl 2)) 162-167
    Google Scholar
  • 11 Gilbertson JR, Miller GM, Goldman MS. et al . Spinal dural arteriovenous fistulas: MR and myelographic findings.  Am J Neurorad. 1995;  16 2049-2057
    Google Scholar
  • 12 Huffmann BC, Gilsbach JM, Thron A. Spinal dural arteriovenous fistulas: a plea for neurosurgical treatment.  Acta Neurochir (Wien). 1995;  135 44-51
    Google Scholar
  • 13 Hurst RW, Kenyon LC, Lavi E. et al . Spinal dural arterio-venous fistula: the pathology of venous hypertensive myelopathy.  Neurology. 1995;  45 ((7)) 1309-1313
    Google Scholar
  • 14 Kinouchi H, Mizoi K, Takahashi A. et al . Dural arteriovenous shunts at the cervicocranial junction.  J Neurosurg. 1998;  89 755-761
    Google Scholar
  • 15 Koch C, Gottschalk S, Giese A. Dural arteriovenous fistula of the lumbar spine presenting with subarachnoid hemorrhage. Case report and review of the literature.  J Neurosurg. 2004;  100 385-391
    Google Scholar
  • 16 Koch C. Spinal dural arterio-venous fistula.  Curr Opin Neurol. 2006;  19 69-75
    Google Scholar
  • 17 Krings T, Mull M, Gilsbach JM. et al . Spinal vascular malformations.  Eur Radiol. 2005;  15 ((2)) 267-278
    Google Scholar
  • 18 Krings T, Coenen VA, Weinzierl M. et al . Spinal dural arteriovenous fistula associated with a spinal perimedullary fistula.  J Neurosurg Spine. 2006;  4 241-245
    Google Scholar
  • 19 Lindqvist C, Berthelsen M, Sullivan M. et al . Spinal arteriovenous malformations: neurological aspects and results of embolization.  Acta Neurol Scand. 1990;  82 51-58
    Google Scholar
  • 20 Marey J, Pego R, Alonso G. et al . Endovascular treatment of dural arteriovenous fistulas with medullary venous drainage. Experience with 18 patients.  Rev Neurol. 1998;  26 ((153)) 793-799 , discussion 799–800
    Google Scholar
  • 21 Mascalchi M, Ferrito G, Quilici N. et al . Spinal vascular malformations: MR angiography after treatment.  Radiology. 2001;  219 346-353
    Google Scholar
  • 22 Narvid J, Hetts SW, Larsen D. et al . Spinal dural arteriovenous fistulae: clinical features and long-term results.  Neurosurgery. 2008;  62 ((1)) 159-166 , ; discussion 166–167
    Google Scholar
  • 23 Niimi Y, Berenstein A, Setton A. et al . Embolization of spinal dural arteriovenous fistulae: results and follow-up.  Neurosurgery. 1997;  40 675-683
    Google Scholar
  • 24 Ohta T, Gomi M, Oowaki H. et al . Chronic venous congestion following embolization of spinal dural arteriovenous fistula.  J Neurosurg Spine. 2008;  9 186-190
    Google Scholar
  • 25 Oldfield EH; Di Chiro G, Quindlen EA. Successful treatment of a group of spinal cord arteriovenous malformations by interruption of dural fistula.  J Neurosurg. 1983;  59 1019-1030
    Google Scholar
  • 26 Pattany PM, Saraf-Lavi E, Bowen BC. MR angiography of the spine and spinal cord.  Top Magn Reson Imaging. 2003;  14 ((6)) 444-460
    Google Scholar
  • 27 Reul J. Spinal dural arteriovenous fistulas: diagnosis and treatment from the neurological point of view.  Klin Neuroradiol. 2005;  15 91-98
    Google Scholar
  • 28 Rizvi T, Garg A, Mishra NK. et al . Metachronous double spinal dural arteriovenous fistulas. Case report and review of the literature.  J Neurosurg Spine. 2006;  4 ((6)) 503-505
    Google Scholar
  • 29 Roccatagliata L, Centanaro F, Castellan L. Venous congestive myelopathy in spinal dural arteriovenous fistula mimicking neoplasia.  Neurol Sci. 2007;  28 ((4)) 212-215
    Google Scholar
  • 30 Sherif C, Gruber A, Bavinzski G. et al . Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistula treatment.  Neuroradiology. 2008;  50 67-74
    Google Scholar
  • 31 Song JK, Vinuela F, Gobin YP. et al . Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors.  J Neurosurg. 2001;  94 ((Suppl 2)) 199-204
    Google Scholar
  • 32 Steinmetz MP, Chow MM, Krishnaney AA. et al . Outcome after the treatment of spinal dural arteriovenous fistulae: a contempory single-institution series and meta-analysis.  Neurosurgery. 2004;  55 77-88
    Google Scholar
  • 33 Sugawara T, Kinouchi H, Itoh Y. et al . Multiple spinal dural arteriovenous fistulas.  Acta Neurochir (Wien). 2005;  147 ((4)) 423-426 , ; discussion 426
    Google Scholar
  • 34 Takami T, Ohata K. et al . Histological characteristics of arterialized medullary vein in spinal dural arteriovenous fistulas related with clinical findings: report of five cases.  Neurol India. 2006;  54 ((2)) 202-204
    Google Scholar
  • 35 Van Dijk JM, Ter Brugge KG, Willinsky RA. et al . Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients.  Stroke. 2002;  33 1578-1583
    Google Scholar
  • 36 Westphal M, Koch C. Management of spinal dural arteriovenous fistulae using an interdisciplinary neuroradiological/neurosurgical approach: experience with 47 cases.  Neurosurgery. 1999;  45 ((3)) 451-457 , ; discussion 457–458
    Google Scholar

1 Both authors contributed equally to this article.

Correspondence

Dr. C. Hessler

University Hospital Hamburg-Eppendorf

Neurosurgery

Martinistraße 52

20246 Hamburg

Germany

Phone: 040/74/105 05 38

Fax: 040/74/103 47 49

Email: chessler@uke.uni-hamburg.de