scholarly journals Management of spinal dural arteriovenouse fistula

2017 ◽  
Vol 31 (4) ◽  
pp. 474-483
Author(s):  
A. Chiriac ◽  
Georgiana Ion ◽  
N. Dobrin ◽  
I. Poeată
Keyword(s):  
Endovascular Treatment ◽  
Vascular Lesions ◽  
Short Discussion ◽  
Endovascular Techniques ◽  
Arteriovenous Fistulae ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
High Interest ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract Spinal dural arteriovenous fistulas are rare vascular lesions whose management is still at high interest between specialists. If microsurgical treatment is still considered as treatment of choice for SDAVFs, endovascular treatment is increasingly grow in interest with the development of endovascular techniques and new embolization materials. In this article we made a short discussion about the spinal dural arteriovenous fistulae on aspects related to anatomy, pathophysiology, diagnosis and treatment, with some general conclusions.

Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 137-144 ◽  
Author(s):  
Nicolaas A. Bakker ◽  
Maarten Uyttenboogaart ◽  
G.J. Luijckx ◽  
Omid S. Eshghi ◽  
Aryan Mazuri ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Meta Analysis ◽  
Treatment Modalities ◽  
Endovascular Techniques ◽  
Recurrence Rates ◽  
Arteriovenous Fistulas ◽  
Initial Failure ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Abstract BACKGROUND: There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery. OBJECTIVE: To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques. METHODS: A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration. RESULTS: A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8–97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1–75.9; P < .001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45–11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66–5.96; P < .001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75–8.37; P = .13). CONCLUSION: Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.

Minimally invasive tubular retractor system for adequate exposure during surgical obliteration of spinal dural arteriovenous fistulas with the aid of indocyanine green intraoperative angiography

2012 ◽  
Vol 17 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Atman Desai ◽  
Kimon Bekelis ◽  
Kadir Erkmen
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Successful Treatment ◽  
Indocyanine Green Angiography ◽  
Intraoperative Angiography ◽  
Tubular Retractor ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5–S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.

scholarly journals СLINICAL ASPECTS, DIAGNOSTICS AND MICROSURGICAL TREATMENT OF SPINAL DURAL ARTERIOVENOUS FISTULAS (LECTURE)

2019 ◽  
Vol 21 (2) ◽  
pp. 53-65
Author(s):  
G. Yu. Evzikov ◽  
V. А. Parfenov ◽  
А. V. Farafontov ◽  
P. V. Kuchuk ◽  
S. А. Kondrashin ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Wide Range ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

The lecture is dedicated to spinal dural arteriovenous fistula – infrequent disorder which not well known among wide range of neurosurgeons. The findings on etiology, clinic and treatment are presented.

scholarly journals Overview of the current role of endovascular and surgical treatment in spinal dural arteriovenous fistulas

2009 ◽  
Vol 26 (1) ◽  
pp. E8 ◽  
Author(s):  
Amir R. Dehdashti ◽  
Leodante B. Da Costa ◽  
Karel G. terBrugge ◽  
Robert A. Willinsky ◽  
Michael Tymianski ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vascular Malformations ◽  
Endovascular Embolization ◽  
Vascular Lesions ◽  
Current Role ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Complete Obliteration ◽  
Spinal Dural Arteriovenous Fistulas

Dural arteriovenous fistulas are the most common vascular malformations of the spinal cord. These benign vascular lesions are considered straightforward targets of surgical treatment and possibly endovascular embolization, but the outcome in these cases depends mainly on the extent of clinical dysfunction at the time of the diagnosis. A timely diagnosis is an equally important factor, with early treatment regardless of the type more likely to yield significant improvements in neurological functioning. The outcomes after surgical and endovascular treatment are similar if complete obliteration of the fistulous site is obtained. In the present study, the authors evaluated the current role of each modality in the management of these interesting lesions.

Surgical treatment of Type I spinal dural arteriovenous fistulas

2012 ◽  
Vol 32 (5) ◽  
pp. E3 ◽  
Author(s):  
Alexander E. Ropper ◽  
Bradley A. Gross ◽  
Rose Du
Keyword(s):  
Low Flow ◽  
Bladder Function ◽  
Neurological Deficits ◽  
Type I ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Presenting Symptoms ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Epidemiological Characteristics

Object Type I spinal dural arteriovenous fistulas (SDAVFs) are low-flow vascular shunts fed by radicular arteries in patients who most often present with myelopathy. Although some fistulas are amenable to endovascular embolization, nearly all can be treated with direct microsurgical obliteration. Methods The authors reviewed their experience in treating 214 craniospinal arteriovenous malformations and/or fistulas over the last 8 years. Of these, 19 were spinal (9%), of which 15 (79%) were Type I SDAVFs. The authors reviewed the patients' epidemiological characteristics, presenting symptoms, and SDAVF angioarchitecture in all cases. They subsequently analyzed surgical obliteration rates and outcomes of all 11 patients who underwent fistula microsurgical obliteration. Results In all patients who underwent microsurgical treatment, complete angiographic obliteration of the fistula was achieved. At follow-up, 10 (91%) of 11 patients exhibited improvement, 1 patient (9%) was the same, and no patients were worse. Specifically, 8 (73%) of 11 patients had improvement in strength and sensation, 5 (71%) of 7 had improvement of bowel/bladder function, and 3 (60%) of 5 had improvement of preoperative paresthesias. There were no wound infections, CSF leaks, or permanent neurological deficits. Conclusions Microsurgical treatment of SDAVF provides direct access to the fistula point, allowing for high obliteration rates with excellent long-term improvement of preoperative deficits and limited periprocedural complications.

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