Multidisciplinary approach in the treatment of spinal dural arteriovenous fistula—results of endovascular and surgical treatment View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2018-09-18

AUTHORS

T. Česák, J. Adamkov, P. Poczos, M. Kanta, A. Krajina, D. Krajíčková, R. Herzig, Martin Vališ

ABSTRACT

BackgroundThe results of treatment for spinal dural arteriovenous fistula (SDAVF) have been controversial. The goal of this study was to compare results of endovascular and surgical treatments to contribute to determining an optimal treatment strategy.MethodsA retrospective analysis of the set of 24 SDAVF patients (11 in the endovascular and 13 in the surgical group) was performed. The clinical effect (using the modified Rankin scale [mRS]), the radicality, and the number of clinical recurrences as well as the impact of age, the level of impairment, and the duration of symptoms before the treatment were evaluated.ResultsThe average age was 60.1 ± 8.4 years. The median duration of symptoms before establishing a diagnosis was 12 (1–70) months. Clinical improvement was reported in 11 out of 24 (45.8%) patients (36.4% following embolization and 53.8% following surgery, p = 0.444). Radical performance was achieved in 47.4% of endovascular versus 92.9% of surgical procedures (p = 0.009). Clinical recurrence was reported in 35.3% of patients in the endovascular group, whereas no clinical recurrence was reported in the surgical group (p = 0.0133). The graphical residuum after 1 surgery out of 14 (7.1%) was cured early during the control angiography. Clinical improvement was reported 42.1% of patients with mRS ≤ 3 versus 60% of patients with mRS ≥ 4 and, in 57.1% of patients aged ≥ 60 versus in 30% of patients < 60 years (p > 0.05 in both cases). The impact of the duration of symptoms on the clinical results was not statistically significant.ConclusionsThe surgical treatment of SDAVF appeared to be a more efficient method in terms of the clinical effect, radicality, and lower recurrence rate in comparison with the endovascular treatment. No statistically significant dependence of the clinical result on age, deficit burden, or symptom duration was found. More... »

PAGES

2439-2448

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00701-018-3672-z

DOI

http://dx.doi.org/10.1007/s00701-018-3672-z

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1107055069

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30225811


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