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Cent Eur Neurosurg 2010; 71(1): 8-12
DOI: 10.1055/s-0029-1224195
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Clues In Spinal Dural Arteriovenous Fistulas – A 30 Year Experience Of 156 Cases

C. Hessler1 [*] , J. Regelsberger1 [*] , U. Grzyska2 , T. Illies2 , H. Zeumer2 , M. Westphal1
  • 1University Hospital Hamburg-Eppendorf, Neurosurgery, Hamburg, Germany
  • 2University Hospital Hamburg-Eppendorf, Neuroradiology, Hamburg, Germany
Further Information

Publication History

Publication Date:
25 September 2009 (online)

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Background: Spinal dural arteriovenous fistulae (SDAVF) are rare but remain the most common type of spinal vascular malformations. Treatment options for SDAVF include endovascular embolization, microsurgical dissection or a combination of both. But the optimal treatment paradigm has yet to be defined and may well be an individualized interdisciplinary combinatorial approach.

Material and Methods: From 1980 to 2008, 156 patients with the diagnosis of SDAVF were treated by neuroradiological and neurosurgical means. Based on the procedure-related complications we retrospectively analyzed our data to elucidate the reasons for endovascular failure and the evolution of the surgical technique.

Results: 156 patients were included in this study. There were 31 (19.9%) female and 125 (80.1%) male patients. Average age at the time of diagnosis was 60.8 years. 102 out of 156 (65.4%) underwent endovascular obliteration, 54 (34.6%) patients were treated primarily by surgery. 134 (85.9%) underwent follow-up examination. A total of 29 (18.6%) out of 156 patients could not be treated successfully by endovascular (9.4%) or surgical (4.1%) means.

Conclusion: Microsurgery can be recommended as the first choice treatment when the fistula's point is unmistakably identified intradurally. Endovascular obliteration may be justifiable in cases with an easy access to a monoradicular feeding artery during diagnostic angiography. Surgery is a definitive treatment with stable long-term results in which procedure-related morbidity is low. During evolution of the combined approach, endovascular coil placement for correct localization of the fistula and the use of intraoperative micro-Doppler was found to be very helpful in increasing the safety of the surgical procedure and minimizing surgical exposure.

Key words

spinal vascular malformation - dural arteriovenous fistula - therapeutic findings

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1 Both authors contributed equally to this article.

Correspondence

Dr. C. Hessler

University Hospital Hamburg-Eppendorf

Neurosurgery

Martinistraße 52

20246 Hamburg

Germany

Phone: 040/74/105 05 38

Fax: 040/74/103 47 49

Email: chessler@uke.uni-hamburg.de

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