Artikel
Clinical outcome and pitfalls in the treatment of spinal dural arteriovenous fistulas
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Autoren
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Neriman Oezkan
- Department of Neurosurgery, University Hospital Essen, Germany
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Ilonka Keitschmann-Andermahr
- Department of Neurosurgery, University Hospital Essen, Germany
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I. Erol Sandalcioglu
- Department of Neurosurgery, University Hospital Essen, Germany; Department of Neurosurgery, KRH Klinikum Nordstadt, Hannover, Germany
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Sophia Goerike
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
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Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany; Institute of Radiology, Klinik Hirslanden, Zurich, Switzerland
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Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Germany
| Veröffentlicht: | 13. Mai 2014 |
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Gliederung
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Objective: The aim of our retrospective study is to demonstrate our experience in the treatment of spinal dural arteriovenous fistulas and to identify factors that influence the neurological outcome of our patients.
Method: Between 2001 and 2013, a consecutive series of 32 patients diagnosed with spinal dural arteriovenous fistula (sDAVF) was treated in our department in collaboration with the Institute of Neuroradiology in an interdisciplinary manner. Diagnosis was established by MRI and selective spinal angiography. Functional pre- and postoperative state was graded according to the Aminoff-Logue disability scale. Occlusion of sDAVF was proven by post-interventional selective angiography.
Results: The average age of 6 (19%) female and 26 (81%) male patients was 64 (41–81) years. The main localization of the spinal fistula was in the thoracic spine (T1–T12) in 21 (66%) patients. Endovascular occlusion of the sDAVF was effected in 5 (16%) patients whereas microsurgical treatment was performed in 25 (78%) patients. 2 (6%) patients underwent surgery after unsuccessful embolization. Incomplete surgical occlusion of the sDAVF was seen in 2 (6%) cases, one of which was operated upon again and the other was treated interventionally. The main preoperative neurological deficits were sensory deficits in 30 (94%), gait disturbance in 26 (81%), motor deficits and bladder dysfunction in 20 (63%) patients. At follow-up, 16 (50%) patients exhibited improvement, 13 (40.9%) remained stable, and 3 (9.4%) worsened as compared to their preoperative neurological state. Specifically, sensory disturbance improved in 10 (62.5%), gait disturbance in 4 (25%), paraparesis in 2 (12.5%) and bowel/bladder dysfunction in 2 (12.5%) patients. In the three patients who worsened, the intraoperative course was uneventful, but postoperative MRI showed progressive edema of the medulla.
Conclusions: The clinical outcome after treatment of sDAVF is good in general. Microsurgical treatment of sDAVF provides direct access to the fistula point and is the treatment of choice in most of the cases.Yet, neurological deterioration of some patients after adequate treatment of sDAVF’s is still a challenge. We postulate that venous thrombosis after adequate treatment of sDAVF may lead to progression of chronic venous congestion of the medulla. Further studies should clarify whether postoperative heparinization could prevent progressive edema and postoperative neurological deterioration.
