Spinal dural arteriovenous fistulas

Experience with endovascular and surgical therapy

Emad N. Eskandar, Lawrence F. Borges, Ronald F. Budzik, Christopher M. Putman, Christopher S. Ogilvy

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

Object. Although the pathophysiology of spinal dural arteriovenous fistulas (AVFs) has recently been elucidated, the optimal treatment strategy for these lesions has yet to be defined. Current management techniques include endovascular embolization or microsurgical obliteration. Methods. The authors reviewed the records and angiograms of all patients with spinal dural AVFs treated at Massachusetts General Hospital over a 6-year period (1992-1998). During this period, it was intended initially to treat all patients with embolization and to reserve surgery for those in whom endovascular treatment failed or in cases in which pretreatment evaluation suggested that endovascular therapy would be ineffective or unsafe. A total of 26 patients with spinal dural AVFs were treated: there were 22 men and 4 women with a mean age of 65 years (range 39-79 years). Lesions were located in the following areas: five in foramen magnum/cervical, 13 in thoracic, five in lumbar, and three in sacral. Twenty-three (88%) of 26 patients underwent embolization and three (12%) of 23 patients underwent surgery as the primary mode of treatment. Of the 23 patients in whom embolization was performed or attempted, nine (39%) ultimately required surgery. All patients were stabilized or improved following definitive treatment, as assessed by the Aminoff-Logue scores. There was one death secondary to a myocardial infarction. Conclusions. These data demonstrate that endovascular therapy can be successful as an initial treatment for the majority of patients; however, there is a 39% failure rate, which is not observed following surgical therapy. Once a definitive therapy has been achieved using either technique virtually all patients are either stabilized or improved.

Original languageEnglish (US)
Pages (from-to)162-167
Number of pages6
JournalJournal of Neurosurgery
Volume96
Issue number2 SUPPL.
StatePublished - Mar 27 2002
Externally publishedYes

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Central Nervous System Vascular Malformations
Therapeutics
Foramen Magnum
Endovascular Procedures
General Hospitals
Angiography
Thorax
Myocardial Infarction

Keywords

  • Arteriovenous fistula
  • Dural
  • Spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)

Cite this

Eskandar, E. N., Borges, L. F., Budzik, R. F., Putman, C. M., & Ogilvy, C. S. (2002). Spinal dural arteriovenous fistulas: Experience with endovascular and surgical therapy. Journal of Neurosurgery, 96(2 SUPPL.), 162-167.

Spinal dural arteriovenous fistulas : Experience with endovascular and surgical therapy. / Eskandar, Emad N.; Borges, Lawrence F.; Budzik, Ronald F.; Putman, Christopher M.; Ogilvy, Christopher S.

In: Journal of Neurosurgery, Vol. 96, No. 2 SUPPL., 27.03.2002, p. 162-167.

Research output: Contribution to journalArticle

Eskandar, EN, Borges, LF, Budzik, RF, Putman, CM & Ogilvy, CS 2002, 'Spinal dural arteriovenous fistulas: Experience with endovascular and surgical therapy', Journal of Neurosurgery, vol. 96, no. 2 SUPPL., pp. 162-167.
Eskandar EN, Borges LF, Budzik RF, Putman CM, Ogilvy CS. Spinal dural arteriovenous fistulas: Experience with endovascular and surgical therapy. Journal of Neurosurgery. 2002 Mar 27;96(2 SUPPL.):162-167.
Eskandar, Emad N. ; Borges, Lawrence F. ; Budzik, Ronald F. ; Putman, Christopher M. ; Ogilvy, Christopher S. / Spinal dural arteriovenous fistulas : Experience with endovascular and surgical therapy. In: Journal of Neurosurgery. 2002 ; Vol. 96, No. 2 SUPPL. pp. 162-167.
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