Document Detail


Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment.
MedLine Citation:
PMID:  18026943     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The optimal treatment of spinal dural arteriovenous fistulae (SDAVF) remains controversial and long-term follow-up data, especially data from multidisciplinary treatment, are rarely available. Thus, long-term outcomes following a multidisciplinary approach to the treatment of SDAVF were investigated. METHODS: The investigation included 26 patients with SDAVF treated at the authors' department over a 15-year period including a follow-up of more than 2 years. The treatment strategy when occlusion of the draining vein could be achieved was to embolize the fistula with Histoacryl, with surgery reserved for those patients unsuitable for embolization. Posttreatment angiography followed by MRI was performed in all patients. Clinical follow-up was performed using the gait and micturition Aminoff-Logue scale scores and the modified Rankin scale score. RESULTS: Embolization was performed in 19 patients (73.1%), and direct surgery in 7 patients (26.9%). Follow-up angiography (at a mean of 21.7 months) showed occlusion of the SDAVF in 24 patients (92.3%). Of the 19 embolized patients, 2 (10.5%) developed recurrence secondary to insufficient occlusion of the SDAVF draining vein, and one of these two patients underwent re-embolization and one re-operation. No negative effects of SDAVF recurrence on the final clinical outcome were identified in either patient. MRI after angiography (at a mean of 91.5 months) demonstrated occlusion of all SDAVFs. After a mean clinical follow-up of 103.4 months there was a statistically significant improvement in both the modified Rankin scale score and the Aminoff-Logue gait scale score (P < 0.05). CONCLUSION: The present multidisciplinary study showed for the first time that embolization leads to stable neuroradiological results and favourable clinical outcomes even for very long follow-up times of more than 100 months. Microsurgery remains the treatment of choice when safe embolization of the draining vein cannot be achieved.
Authors:
Camillo Sherif; Andreas Gruber; Gerhard Bavinzski; Harald Standhardt; Georg Widhalm; Daniel Gibson; Bernd Richling; Engelbert Knosp
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-11-20
Journal Detail:
Title:  Neuroradiology     Volume:  50     ISSN:  1432-1920     ISO Abbreviation:  Neuroradiology     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2007-12-24     Completed Date:  2008-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1302751     Medline TA:  Neuroradiology     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  67-74     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Medical University Vienna, Vienna, Austria. camillo.sherif@meduniwien.ac.at
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living / classification
Adult
Aged
Angiography
Central Nervous System Vascular Malformations / therapy*
Combined Modality Therapy
Embolization, Therapeutic / methods
Enbucrilate / therapeutic use
Female
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Male
Microsurgery / methods
Middle Aged
Neurologic Examination
Patient Care Team*
Recurrence
Retreatment
Tissue Adhesives / therapeutic use
Chemical
Reg. No./Substance:
0/Tissue Adhesives; 6606-65-1/Enbucrilate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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