Document Detail


Multidisciplinary management of spinal dural arteriovenous fistulas: clinical presentation and long-term follow-up in 49 patients.
MedLine Citation:
PMID:  12052994     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: In the early 1980s, it was demonstrated that surgical intradural division of the shunting vein to the medullary venous plexus cures a spinal dural arteriovenous fistula (DAVF) at low morbidity. There is, however, growing literature to support endovascular therapy. METHODS: The clinical features of 49 consecutive patients with a spinal DAVF treated at a single institution between 1986 and 2001 were studied (mean age, 63 years; range, 28 to 78 years; 80% male). When possible, embolization was offered as the initial treatment. Endovascular treatment was considered adequate only if the proximal shunting vein could be occluded with liquid adhesive embolics. Motor and bladder function was evaluated with Aminoff scores an average of 32.3 months after treatment. RESULTS: All but 1 patient presented with myelopathy. At a mean of 2.3 years after symptom onset, 48 DAVFs were angiographically demonstrated. Since 1999, gadolinium-enhanced MR angiography was additionally performed in 7 patients to point out the level of the DAVF. Endovascular embolization could be attempted in 44 of the 48 DAVFs and resulted in a cure in 11 (25%). Thirty-five DAVFs were surgically cured; 2 patients refused surgery after failed embolization. Angiographic confirmation of the treatment result was available in 97.7% of the patients. No permanent complications of either embolization or surgery were noted. Motor and bladder function scores were significantly improved in 35 patients who had long-term follow-up (both P<0.005). CONCLUSIONS: Endovascular treatment with liquid adhesive material provided a result equal to surgery in 25% of patients, overall resulting in a significant amelioration in the neurological status of patients with a spinal DAVF.
Authors:
J Marc C Van Dijk; Karel G TerBrugge; Robert A Willinsky; Richard I Farb; M Christopher Wallace
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  33     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-07     Completed Date:  2002-07-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1578-83     Citation Subset:  IM    
Affiliation:
Brain Vascular Malformation Study Group, University of Toronto, Toronto Western Hospital, Division of Neurosurgery, Ontario, Canada. vandijk.md@planet.nl.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Central Nervous System Vascular Malformations / complications,  diagnosis*,  therapy*
Disease Management
Embolization, Therapeutic
Female
Follow-Up Studies
Humans
Magnetic Resonance Angiography
Male
Middle Aged
Pain / etiology
Paraparesis / etiology
Prospective Studies
Retrospective Studies
Spinal Cord Diseases / etiology
Spinal Diseases / complications,  diagnosis*,  therapy*
Time
Treatment Outcome
Urinary Bladder, Neurogenic / etiology
Vascular Surgical Procedures

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


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