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Acta Neurochirurgica

, Volume 160, Issue 12, pp 2439–2448 | Cite as

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

  • T. Česák
  • J. Adamkov
  • P. Poczos
  • M. Kanta
  • A. Krajina
  • D. Krajíčková
  • R. Herzig
  • Martin Vališ
Original Article - Vascular Neurosurgery - Other
  • 84 Downloads
Part of the following topical collections:
  1. Vascular Neurosurgery – Other

Abstract

Background

The 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.

Methods

A 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.

Results

The 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.

Conclusions

The 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.

Keywords

Spinal dural arteriovenous fistula Endovascular therapy Microsurgery Recurrence 

Notes

Funding

This work was supported in part by grants from the Ministry of Health of the Czech Republic (RVO – FN HK 00179906) and from Charles University, Czech Republic (PROGRES Q40).

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018
corrected publication 2018

Authors and Affiliations

  • T. Česák
    • 1
  • J. Adamkov
    • 1
  • P. Poczos
    • 1
  • M. Kanta
    • 1
  • A. Krajina
    • 2
  • D. Krajíčková
    • 3
  • R. Herzig
    • 3
  • Martin Vališ
    • 3
  1. 1.Department of Neurosurgery, Comprehensive Stroke CenterCharles University Faculty of Medicine and University HospitalHradec KrálovéCzech Republic
  2. 2.Department of Radiology, Comprehensive Stroke CenterCharles University Faculty of Medicine and University HospitalHradec KrálovéCzech Republic
  3. 3.Department of Neurology, Comprehensive Stroke Center, Faculty of Medicine and University HospitalCharles University in PragueHradec KrálovéCzech Republic

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