TY - JOUR
T1 - Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas
T2 - A multicenter study of 195 patients
AU - Takai, Keisuke
AU - Endo, Toshiki
AU - Yasuhara, Takao
AU - Seki, Toshitaka
AU - Watanabe, Kei
AU - Tanaka, Yuki
AU - Kurokawa, Ryu
AU - Kanaya, Hideaki
AU - Honda, Fumiaki
AU - Itabashi, Takashi
AU - Ishikawa, Osamu
AU - Murata, Hidetoshi
AU - Tanaka, Takahiro
AU - Nishimura, Yusuke
AU - Eguchi, Kaoru
AU - Takami, Toshihiro
AU - Watanabe, Yusuke
AU - Nishida, Takeo
AU - Hiramatsu, Masafumi
AU - Ohtonari, Tatsuya
AU - Yamaguchi, Satoshi
AU - Mitsuhara, Takafumi
AU - Matsui, Seishi
AU - Uchikado, Hisaaki
AU - Hattori, Gohsuke
AU - Yamahata, Hitoshi
AU - Taniguchi, Makoto
N1 - Funding Information:
This study was financially supported by the Tokyo Metropolitan Government (grant number R010603007).
Publisher Copyright:
© 2021 The authors.
PY - 2021/3
Y1 - 2021/3
N2 - Objective: The purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs). Methods: Data from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed. Results: Spinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7-546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of ≥ 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02). Conclusions: Based on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.
AB - Objective: The purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs). Methods: Data from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed. Results: Spinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7-546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of ≥ 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02). Conclusions: Based on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.
KW - Dural arteriovenous shunts
KW - Endovascular embolization
KW - Spinal arteriovenous shunts
KW - Spinal vascular malformations
KW - Surgery
KW - Vascular disorders
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U2 - 10.3171/2020.6.SPINE20309
DO - 10.3171/2020.6.SPINE20309
M3 - Article
C2 - 33186917
AN - SCOPUS:85102186321
VL - 34
SP - 514
EP - 521
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
SN - 1547-5654
IS - 3
ER -