Toru Sasamori1, Kazutoshi Hida2, Shunsuke Yano2, Takeshi Asano3, Toshitaka Seki4, Kiyohiro Houkin4. 1. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North-15 West-7, Kita-ku, Sapporo, 060-8638, Japan. mo_ri25@yahoo.co.jp. 2. Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan. 3. Department of Neurosurgery, Asahikawa Red Cross Hospital, Asahikawa, Japan. 4. Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North-15 West-7, Kita-ku, Sapporo, 060-8638, Japan.
Abstract
PURPOSE: To examine the validity of our treatment strategy for spinal dural arteriovenous fistulae (SDAVF), based on the treatment results and the long-term outcome. METHODS: This study included 50 SDAVF patients (38 men, 12 women, mean age 63.2 years) with progressive myelopathy. The treatment strategy involved embolization as the initial management tool and surgery if embolization was considered unsuitable. Their medical records were evaluated to identify the treatment results and functional outcomes. The mean follow-up period was 81.2 months (range 27-184 months). RESULTS: Complete obliteration was achieved in 22 (71.0%) of 31 embolized patients and in 18 of 19 (94.7%) operated patients. The initial success rate was significantly lower in embolized than operated patients. At the last follow-up, 33 of the 50 patients (66%) manifested improved gait and 16 (32%) improved micturition. The activity of daily living (ADL) was improved in 33 (66%). When we compared the rates of functional improvement at the last follow-up, there was no significant difference between patients treated initially by embolization or surgery. CONCLUSIONS: The long-term outcomes in SDAVF patients treated by multidisciplinary management with first-line embolization were comparable to those in earlier surgical series. However, our results were unable to demonstrate the superiority of endovascular embolization to surgical treatment for SDAVF. For the purpose of justifying endovascular embolization as a first-line treatment for SDAVF, it will be necessary to show further improvement in both the initial treatment success and the complication rates.
PURPOSE: To examine the validity of our treatment strategy for spinal dural arteriovenous fistulae (SDAVF), based on the treatment results and the long-term outcome. METHODS: This study included 50 SDAVFpatients (38 men, 12 women, mean age 63.2 years) with progressive myelopathy. The treatment strategy involved embolization as the initial management tool and surgery if embolization was considered unsuitable. Their medical records were evaluated to identify the treatment results and functional outcomes. The mean follow-up period was 81.2 months (range 27-184 months). RESULTS: Complete obliteration was achieved in 22 (71.0%) of 31 embolized patients and in 18 of 19 (94.7%) operated patients. The initial success rate was significantly lower in embolized than operated patients. At the last follow-up, 33 of the 50 patients (66%) manifested improved gait and 16 (32%) improved micturition. The activity of daily living (ADL) was improved in 33 (66%). When we compared the rates of functional improvement at the last follow-up, there was no significant difference between patients treated initially by embolization or surgery. CONCLUSIONS: The long-term outcomes in SDAVFpatients treated by multidisciplinary management with first-line embolization were comparable to those in earlier surgical series. However, our results were unable to demonstrate the superiority of endovascular embolization to surgical treatment for SDAVF. For the purpose of justifying endovascular embolization as a first-line treatment for SDAVF, it will be necessary to show further improvement in both the initial treatment success and the complication rates.
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