gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

A 20-year single-center experience in a series of 148 microsurgically treated spinal dural arteriovenous fistulas

Meeting Abstract

  • M.F. Oertel - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland; Universitätsklinik für Neurochirurgie, Inselspital, Universität Bern, Schweiz
  • V. Rohde - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland; Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum der Georg-August-Universität Göttingen, Göttingen, Deutschland
  • M. Mull - Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
  • M.H.T. Reinges - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
  • A.K. Thron - Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
  • J.M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland
  • F.J. Hans - Neurochirurgische Klinik, Universitätsklinikum der RWTH Aachen, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.12

DOI: 10.3205/11dgnc077, URN: urn:nbn:de:0183-11dgnc0778

Veröffentlicht: 28. April 2011

© 2011 Oertel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: Although spinal dural arteriovenous fistulas (SDAVF) are the most common vascular malformations of the spinal cord their preferred and best therapeutic option remains controversial. Therefore, the authors present their 20-year experience with SDAVF to characterize the clinical, neuroimaging and treatment data of patients operated on SDAVF and to analyse risk profile and incidence of complications and resurgery in the microsurgical treatment of SDAVF.

Methods: From 1990 to 2010, 148 SDAVF in 144 consecutive patients (116 men and 28 women) were angiographically confirmed and microsurgically treated at our institution. The mean patient age at surgery was 61.5 years (range 23 to 85 years). With the exception of 1/144 asymptomatic patient, the presenting symptoms were consistent with progressive myelopathy (142/144) or included isolated back pain (1/144). Thoracic SDAVF location (96/148) was predominant followed by the lumbar (37/148), sacral (9/148) and cervical (6/148) site. During surgery, 1/148 concurrent perimedullary fistula was identified and subsequently occluded. All patients were available for follow-up re-evaluation within 6 months postoperatively. The scale of Aminoff and Logue was used for evaluation of the clinical results.

Results: Immediately postoperatively, 104/144 patients improved neurologically, no clinical change was seen in 34/144 patients, 6/144 patients got worse after surgery. 142/144 patients available for short-term evaluation remained improved (116/144) or stabilized (26/144), 2/144 patients subsequently deteriorated postoperatively. A second operation because of residual and recanalized (6/144) or multiple SDAVF (4/144) was indicated in 10/144 cases. Following microsurgery in 154 cases, surgery-related complications included 3/154 wound healing disturbances and 2/154 infections, 3/154 subcutaneous accumulations of CSF and 1/154 spinal epidural haematoma or pneumocephalus each, requiring reoperation in 3/154 surgeries.

Conclusions: Even if 45% of patients being 65 years of age or older usually with multiple comorbidities, complications associated with microsurgery, recurrences and reoperations are infrequent. Microsurgical occlusion of SDAVF appears to be an adequate, secure and definite therapeutic option that prevents progressive neurological deterioration and results in clinical improvement and good outcome in the majority of patients. Therefore, for the authors microsurgery is the preferred technique to treat SDAVF.