Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients

Keisuke Takai; Toshiki Endo; Takao Yasuhara; Toshitaka Seki; Kei Watanabe; Yuki Tanaka; Ryu Kurokawa; Hideaki Kanaya; Fumiaki Honda; Takashi Itabashi; Osamu Ishikawa; Hidetoshi Murata; Takahiro Tanaka; Yusuke Nishimura; Kaoru Eguchi; Toshihiro Takami; Yusuke Watanabe; Takeo Nishida; Masafumi Hiramatsu; Tatsuya Ohtonari; Satoshi Yamaguchi; Takafumi Mitsuhara; Seishi Matsui; Hisaaki Uchikado; Gohsuke Hattori; Hitoshi Yamahata; Makoto Taniguchi

doi:10.3171/2020.6.SPINE20309

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Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients

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Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients

Keisuke Takai, Toshiki Endo, Takao Yasuhara, Toshitaka Seki, Kei Watanabe, Yuki Tanaka, Ryu Kurokawa, Hideaki Kanaya, Fumiaki Honda, Takashi Itabashi, …

Journal of neurosurgery. Spine, Vol.34(3), pp.514-521

03/01/2021

DOI: 10.3171/2020.6.SPINE20309

PMID: 33186917

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Abstract

OBJECTIVE The purpose of the present study was to compare the treatment success rates of primary neurosurgical and endovascular treatments in patients with spinal dural arteriovenous fistulas (dAVFs). METHODS Data from 199 consecutive patients with thoracic and lumbosacral spinal dAVFs were collected from 18 centers. Angiographic and clinical findings, the rate of initial treatment failure or recurrence by procedures, risk factors for treatment failure, complications, and neurological outcomes were statistically analyzed. RESULTS Spinal dAVFs were frequently detected in the thoracic region (81%), fed by a single feeder (86%), and shunted into an intradural vein via the dura mater. The fistulous connection between the feeder(s) and intradural vein was located at a single spinal level in 195 patients (98%) and at 2 independent levels in 4 patients (2%). Among the neurosurgical (n = 145), and endovascular (n = 50) treatment groups of single dAVFs (n = 195), the rate of initial treatment failure or recurrence was significantly higher in the index endovascular treatment group (0.68% and 36%). A multivariate analysis identified endovascular treatment as an independent risk factor with significantly higher odds of initial treatment failure or recurrence (OR 69; 95% CI 8.7-546). The rate of complications did not significantly differ between the two treatment groups (4.1% for neurosurgical vs 4.0% for endovascular treatment). With a median follow-up of 26 months, improvements of >= 1 point in the modified Rankin Scale (mRS) score and Aminoff-Logue gait and Aminoff-Logue micturition grades were observed in 111 (56%), 121 (61%), and 79 (40%) patients, respectively. Independent risk factors for lack of improvement in the Aminoff-Logue gait grades were multiple treatments due to initial treatment failure or recurrence (OR 3.1) and symptom duration (OR 1.02). CONCLUSIONS Based on data obtained from the largest and most recently assessed multicenter cohort, the present study shows that primary neurosurgery is superior to endovascular treatment for the complete obliteration of spinal dAVFs by a single procedure.

Clinical Neurology

Life Sciences & Biomedicine

Neurosciences & Neurology

Science & Technology

Surgery

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Title: Subtitle: Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas: a multicenter study of 195 patients
Creators: Keisuke Takai - Tokyo Metropolitan Neurological Hospital
Toshiki Endo - Kohnan Hospital
Takao Yasuhara - Okayama University
Toshitaka Seki - Hokkaido University Hospital
Kei Watanabe - Niigata University Medical and Dental Hospital
Yuki Tanaka - Niigata University Medical and Dental Hospital
Ryu Kurokawa - Dokkyo Medical University
Hideaki Kanaya - Dokkyo Medical University
Fumiaki Honda - 5Department of Neurosurgery, Gunma University Hospital, Gunma;
Takashi Itabashi - Japanese Red Cross Narita Hospital
Osamu Ishikawa - University of Tokyo Hospital
Hidetoshi Murata - Yokohama City University
Takahiro Tanaka - Yokohama City University
Yusuke Nishimura - Nagoya University Hospital
Kaoru Eguchi - Nagoya University Hospital
Toshihiro Takami - Osaka City University
Yusuke Watanabe - Osaka City University
Takeo Nishida - Osaka University
Masafumi Hiramatsu - Okayama University
Tatsuya Ohtonari - 14Department of Spinal Surgery, Brain Attack Center, Ota Memorial Hospital, Hiroshima.
Satoshi Yamaguchi - Hiroshima University Hospital
Takafumi Mitsuhara - Hiroshima University Hospital
Seishi Matsui - Ehime University
Hisaaki Uchikado - Kurume University Hospital
Gohsuke Hattori - Kurume University Hospital
Hitoshi Yamahata - Kagoshima University Hospital
Makoto Taniguchi - Tokyo Metropolitan Neurological Hospital
Resource Type: Journal article
Publication Details: Journal of neurosurgery. Spine, Vol.34(3), pp.514-521
DOI: 10.3171/2020.6.SPINE20309
PMID: 33186917
NLM abbreviation: J Neurosurg Spine
ISSN: 1547-5654
eISSN: 1547-5646
Publisher: American Association of Neurological Surgeons
Number of pages: 8
Grant note: R010603007 / Tokyo Metropolitan Government
Language: English
Date published: 03/01/2021
Academic Unit: Neurosurgery
Record Identifier: 9984303899902771

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