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Microsurgery Versus Endovascular Treatment - Which Is Adequate for Initial Treatment of Spinal Dural Arteriovenous Fistula: A Case Series

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Abstract
Objective: Considering the adverse natural history of spinal dural arteriovenous fistula (sDAVF), clinical outcomes may be worsened if the initial occlusive trial does not achieve complete fistula occlusion. We aimed to analyze the initial success rate of microsurgery and embolization and confirm the effects of initial treatment success on the clinical outcomes of sDAVF patients. In addition, we investigated the factors associated with initial treatment failure.

Methods: A total of 38 patients treated for sDAVF at a single institution over a 14-year period were retrospectively reviewed. Clinical outcomes according to the initial treatment modality were quantitatively analyzed. Demographic characteristics and angioarchitecture data were evaluated to identify factors associated with initial treatment failure.

Results: In the study population, 34 patients underwent embolization as the initial treatment, and complete occlusion of the fistula was achieved in 13 patients (38%). However, all patients who underwent microsurgery showed complete fistula occlusion. Among patients with initial treatment success, gait and micturition were improved with statistical significance (p< 0.001 each). However, in cases of initial treatment failure, only mild improvements in gait and micturition were observed, which were not statistically significant (p= 0.097 and p= 0.375, respectively). A narrow feeding artery diameter (p= 0.007) and embolization of the artery only (p= 0.002) were identified as factors associated with initial treatment failure.

Conclusion: To achieve symptomatic improvement and prevent neurological deterioration due to recurrence, the initial definite occlusion of the fistula is important. Despite advances in endovascular techniques, microsurgical occlusion is still superior in terms of initial complete obliteration.
Author(s)
오영규허연전상용노성우박진훈
Issued Date
2021
Type
Article
Keyword
Arteriovenous fistulaEmbolizationMicrosurgery
DOI
10.14245/ns.2040826.413
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8025
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_nrf_kci_oai_kci_go_kr_ARTI_9828279&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Microsurgery%20Versus%20Endovascular%20Treatment%20-%20Which%20Is%20Adequate%20for%20Initial%20Treatment%20of%20Spinal%20Dural%20Arteriovenous%20Fistula:%20A%20Case%20Series&amp;offset=0&amp;pcAvailability=true
Publisher
NEUROSPINE
Location
대한민국
Language
영어
ISSN
2586-6583
Citation Volume
18
Citation Number
2
Citation Start Page
344
Citation End Page
354
Appears in Collections:
Medicine > Medicine
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