157 Open and Endovascular Treatment of Spinal Dural Arteriovenous Fistulae: A 10-Year Experience.

INTRODUCTION: Vascular malformations of the spine represent rare clinical entities with profound neurological implications. Previously reported studies on management strategies for spinal dural arteriovenous fistulas (sDAVFs) were prior to the advent of modern liquid embolic agents. We present our institutional experience with endovascularly and surgically treated sDAVFs.

METHODS: We performed an observational, retrospective, single-center study case series on sDAVFs treated with endovascular embolization, microsurgical occlusion, or both between 2004 and 2013. The mode, efficacy, and clinical effect of treatment were evaluated.

RESULTS: A total of 47 patients with spinal arteriovenous malformations were evaluated with spinal angiography, of which 34 were type 1 sDAVFs, (thoracic 19, lumbar 11, and cervical 2). Twenty-nine or 85% of the patients were male with a median age of 63.3 years. Twenty patients underwent primary endovascular embolization (Onyx 16, nBCA 4), and 14 patients underwent primary surgical clipping. At a mean follow-up of 36 weeks, 5 patients treated with endovascular embolization demonstrated persistent arteriovenous shunting, while no surgically treated patients demonstrated lesion persistence (P = .0237), via angiography or magnetic resonance angiography. Thirty (88%) patients experienced some resolution of their presenting symptoms (embolization 17 [84%], surgery 12 [92%], P = 1.00).

CONCLUSION: Microsurgical occlusion remains the most definitive treatment modality for sDAVFs, although modern endovascular techniques remain a viable option for the initial treatment of anatomically amenable lesions. Treatment of these lesions usually results in some clinical improvement.