Surgical treatment of spinal dural arteriovenous fistulae: A consecutive series of 154 patients

Andrea Saladino, John L D Atkinson, Alejandro A. Rabinstein, David G. Piepgras, W. Richard Marsh, William E. Krauss, Timothy J. Kaufmann, Giuseppe Lanzino

Research output: Contribution to journalArticle

Abstract

Background: Embolization of spinal dural arteriovenous fistulae (SDVAFs) has emerged as an alternative to surgery. However, surgical disconnection is a simple and effective procedure. Objective: To review results and complications of surgical treatment of 154 consecutive SDAVFs. Methods: The records of 154 consecutive patients with SDAVFs were retrospectively reviewed. Results: There were 120 males and 34 females (male/female ratio 3.5:1, mean age 63.6 years). The SDAVFs were located at the thoracic level in 92 patients and at the lumbar and sacral spine levels in 45 and 15 patients, respectively. The most common presenting symptoms were motor dysfunction (65 patients), sensory loss (31 patients), and paresthesias without sensory loss (13 patients). The mean interval from symptom onset to definitive diagnosis was 24.7 months (median 12 months). Surgery resulted in complete exclusion of the fistula at first attempt in 146 patients (95%). There were no deaths or major neurological complications related to the surgery. Six percent of patients experienced subjective or objective worsening of preoperative symptoms and signs by the time of discharge that persisted at follow-up. Other surgical complications consisted of wound infection in 2 patients and deep venous thrombosis in 3. Eight patients were lost to follow-up; 141 patients (96.6%) experienced improvement (120 patients, 82.2%) or stability (21 patients, 14.4%) of motor function at last follow-up compared with their preoperative status. Other symptoms such as numbness, sphincter dysfunction, and dysesthesias/neuropathic pain improved in 51.5%, 45%, and 32.6%, respectively. Conclusion: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.

Original languageEnglish
Pages (from-to)1350-1357
Number of pages8
JournalNeurosurgery
Volume67
Issue number5
DOIs
Publication statusPublished - Nov 2010

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Central Nervous System Vascular Malformations
Therapeutics
Paresthesia
Hypesthesia
Lost to Follow-Up
Neuralgia
Wound Infection
Venous Thrombosis
Signs and Symptoms
Fistula

Keywords

  • Complications
  • Outcome
  • Progressive myelopathy
  • Spinal angiography
  • Spinal dural arteriovenous fistula
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Saladino, A., Atkinson, J. L. D., Rabinstein, A. A., Piepgras, D. G., Marsh, W. R., Krauss, W. E., ... Lanzino, G. (2010). Surgical treatment of spinal dural arteriovenous fistulae: A consecutive series of 154 patients. Neurosurgery, 67(5), 1350-1357. https://doi.org/10.1227/NEU.0b013e3181ef2821

Surgical treatment of spinal dural arteriovenous fistulae : A consecutive series of 154 patients. / Saladino, Andrea; Atkinson, John L D; Rabinstein, Alejandro A.; Piepgras, David G.; Marsh, W. Richard; Krauss, William E.; Kaufmann, Timothy J.; Lanzino, Giuseppe.

In: Neurosurgery, Vol. 67, No. 5, 11.2010, p. 1350-1357.

Research output: Contribution to journalArticle

Saladino, A, Atkinson, JLD, Rabinstein, AA, Piepgras, DG, Marsh, WR, Krauss, WE, Kaufmann, TJ & Lanzino, G 2010, 'Surgical treatment of spinal dural arteriovenous fistulae: A consecutive series of 154 patients', Neurosurgery, vol. 67, no. 5, pp. 1350-1357. https://doi.org/10.1227/NEU.0b013e3181ef2821
Saladino, Andrea ; Atkinson, John L D ; Rabinstein, Alejandro A. ; Piepgras, David G. ; Marsh, W. Richard ; Krauss, William E. ; Kaufmann, Timothy J. ; Lanzino, Giuseppe. / Surgical treatment of spinal dural arteriovenous fistulae : A consecutive series of 154 patients. In: Neurosurgery. 2010 ; Vol. 67, No. 5. pp. 1350-1357.
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abstract = "Background: Embolization of spinal dural arteriovenous fistulae (SDVAFs) has emerged as an alternative to surgery. However, surgical disconnection is a simple and effective procedure. Objective: To review results and complications of surgical treatment of 154 consecutive SDAVFs. Methods: The records of 154 consecutive patients with SDAVFs were retrospectively reviewed. Results: There were 120 males and 34 females (male/female ratio 3.5:1, mean age 63.6 years). The SDAVFs were located at the thoracic level in 92 patients and at the lumbar and sacral spine levels in 45 and 15 patients, respectively. The most common presenting symptoms were motor dysfunction (65 patients), sensory loss (31 patients), and paresthesias without sensory loss (13 patients). The mean interval from symptom onset to definitive diagnosis was 24.7 months (median 12 months). Surgery resulted in complete exclusion of the fistula at first attempt in 146 patients (95{\%}). There were no deaths or major neurological complications related to the surgery. Six percent of patients experienced subjective or objective worsening of preoperative symptoms and signs by the time of discharge that persisted at follow-up. Other surgical complications consisted of wound infection in 2 patients and deep venous thrombosis in 3. Eight patients were lost to follow-up; 141 patients (96.6{\%}) experienced improvement (120 patients, 82.2{\%}) or stability (21 patients, 14.4{\%}) of motor function at last follow-up compared with their preoperative status. Other symptoms such as numbness, sphincter dysfunction, and dysesthesias/neuropathic pain improved in 51.5{\%}, 45{\%}, and 32.6{\%}, respectively. Conclusion: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.",
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