gms | German Medical Science

Methods: A retrospective data analysis of all 51 patients treated for SDAVF between 1999 and 2016 including quality of life (SF-36) process of symptoms (Aminoff-Logue-Score (ALS), Janda). Patients and lesion-related factors were compiled in a database. Statistical analysis were performed using SPSS 13.

Results: The 51 pts. (3:1 male/female) had a median age of 66 years (range:45-83 years). Symptom duration before the diagnosis was established ranged from 0-60 months with a median 8 months +/- 15.5. Surgery was performed in 86.3 % (44/51), embolization in 13.7 % (7/51) of the patients. Complications occurred in 25.5 % (13/51) and the two most common events were epidural hemorrhage or deep veinous thrombosis. Complication rates were similar but slightly less after surgery. Most importantly, recurrence rates revealed a significant difference (p=0.007) in favor of surgical treatment: only 1 of 43 surgically treated patients (2%), but 3 of 7 pts. experienced failure after endovascular treatment (43 %). Using the modified ALS, short-term outcome revealed minimal worsening (OP:+0.13,E: +0.14) (directly after treament) and a notable long-term improvement (median: 16 months) for surgery (-0.35) and embolization (-0.2). The perception of the patients 30 days after treatment showed a better score after embolization (-0.8) compared to surgery (+0.55). However, in the long-term-follow up (median: 6 years) both treatment modalities had similar outcomes (OP: +0.68, E: +0.83). AL-scores were significantly better, if the patients had a shorter time to diagnosis (<8 months, p=0.05) or if they were below 70 years of age (p= 0.002). Quality of life and neurological symptoms improved initially (embolization > surgery) but deteriorated over time comparable to the preinterventional status.

Discussion: Our study demonstrates in a single-departmental retrospective cohort that a shorter time to diagnosis correlates with a significantly better ALS-Outcome and additionally decreases the risk of recurrences. Younger age correlates also with ALS-Outcome. Endovascular treatment had an unacceptable high failure rate, whereas microsurgery was extremely successful in SDAVF closure. Nonsurprisingly, pts. had less complaints after endovascular compared to surgical closure of the SDAVF. In the long-term-follow up patients of both treatments had comparable results and presented a status which – on average - was comparable to the preintervention state. In summary, pts. can be instructed that the aim of any intervention is to stop progression of neurological symptoms but not cure of existing deficits.