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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Defining the role of microsurgery in the treatment of spinal dural arteriovenous fistulas

Meeting Abstract

  • Markus F. Oertel - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen, Deutschland
  • Veit Rohde - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen, Deutschland; Neurochirurgische Klinik, Universitätsklinikum der Georg-August-Universität, Göttingen, Deutschland
  • Michael Mull - Abteilung für Neuroradiologie, Universitätsklinikum der RWTH, Aachen, Deutschland
  • Joachim M. Gilsbach - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen, Deutschland
  • Armin K. Thron - Abteilung für Neuroradiologie, Universitätsklinikum der RWTH, Aachen, Deutschland
  • Franz-Josef Hans - Neurochirurgische Klinik, Universitätsklinikum der RWTH, Aachen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocV1530

DOI: 10.3205/10dgnc007, URN: urn:nbn:de:0183-10dgnc0079

Published: September 16, 2010

© 2010 Oertel et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Although spinal dural arteriovenous fistulas (SDAVF) are the mostly encountered vascular malformations of the spinal cord, their preferred and optimal treatment remains controversial. Thus, based on experience with the largest series of microsurgically treated SDAVF and analysis of the longest postoperative follow-up interval of patients with SDAVF reported so far, the purpose of this study was to characterize the treatment and outcome data of patients operated on SDAVF and to define the role and importance of microsurgery in the management of SDAVF.

Methods: Between 1990 and 2005, 110 SDAVF in 107 patients (84 males, 23 females) were angiographically confirmed and microsurgically treated at our department. The mean patient age at surgery was 60 years (range, 23 to 86 years). The presenting symptoms were consistent with progressive myelopathy (106/107) or included isolated back pain (1/107). Thoracic (69/110) location was predominant followed by the lumbar (31/110), sacral (6/110) and cervical (4/110) site. During surgery, 1/110 concurrent perimedullary fistula was identified and subsequently occluded. 107/107 patients were available for short-term examination (within 3 months), 62/107 patients for hitherto long-term follow-up evaluation (5 to 20 years) postoperatively. The clinical outcome was assessed using the Aminoff-Logue scale.

Results: During short-interval follow-up, 79/107 patients improved neurologically, no clinical change was seen in 26/107 patients, 2/107 patients got worse after surgery. 51/62 patients available for long-term evaluation remained improved (46/62) or stabilized (5/62), 11/62 patients subsequently deteriorated postoperatively. Surgery-related complications included 3/107 wound healing disturbances, 2/107 subcutaneous accumulations of CSF and 1/107 spinal epidural haematoma, requiring reoperation in 2/107 cases. A second operation because of residual and recanalized (5/107) or dual SDAVF (3/107) was indicated in 8/107 cases.

Conclusions: Microsurgical obliteration of SDAVF as a facile, immediate, secure and definite therapeutic option prevents progressive neurological deterioration and results in persistent clinical improvement and favourable long-term outcome in the majority of patients. Complications associated with surgery, reoperations and recurrences are exceptional. Therefore, microsurgery appears to be an ideal therapeutic approach and should act the leading role in the treatment of SDAVF.