Artikel
Microsurgical obliteration of type I spinal AVM
Mikrochirurgische Obliteration spinaler Typ I AVM
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Autoren
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M.F. Oertel
- Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
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V. Rohde
- Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
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F.J. Hans
- Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
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M. Mull
- Abteilung für Neuroradiologie, Universitätsklinikum der RWTH Aachen
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A. Thron
- Abteilung für Neuroradiologie, Universitätsklinikum der RWTH Aachen
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J.M. Gilsbach
- Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Treatment options for spinal dural arteriovenous fistulae (Type I spinal AVM) include microsurgical obliteration, endovascular embolization and a combined interdisciplinary approach. A 10-year single-institution retrospective review of experience with operative management of Type I spinal AVM is presented in order to evaluate treatment efficiency, functional patient outcome and prognosis following surgery.
Methods: The data of 75 consecutive patients (57 males, 18 females) with microsurgically treated Type I spinal AVM between 1990 and 2000 was analyzed in retrospect. The mean patient age was 59 years (range 32 to 84 years). All patients were available for short-term examination (≤3 months) and 54/75 patients for long-term follow-up evaluation (≥5 years, range 5 to 15 years) postoperatively. Clinical outcome was assessed using the disability scale of Aminoff and Logue.
Results: Lesion location included: 3/75 foramen magnum and cervical, 49/75 thoracic, 19/75 lumbar, 4/75 sacral. Complications associated with surgery were infrequent (3/75 wound healing disturbances, 1/75 spinal epidural haematoma, 1/75 subcutaneous accumulation of CSF). 5/75 patients required reoperation because of a residual and recanalized (4/75) or second fistula (1/75). In the early postoperative phase, 55/75 patients improved neurologically. The symptomatology in 18/75 patients remained unchanged, in 2/75 patients the symptoms deteriorated after surgery. 44/54 of the patients available for long-term follow-up remained improved (41/54) or stabilized (3/54), in 10/54 patients the symptomatology increased after surgery.
Conclusions: Microsurgical obliteration offered good and lasting results in 76% of the patients and therefore should be considered first line therapy for patients with Type I spinal AVM. Nevertheless, 24% of the patients showed an incomplete recovery or progressive functional decline in the postoperative period during the long-term follow-up. Therefore Type I spinal AVMs still represent a seriously disabling disease, which has to be considered when discussing the prognosis of Type I spinal AVMs. with patients.
