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An Update on Spinal Dural Arteriovenous Fistulae: Case Series and Systematic Review
George Vavoulis1, Dimitrios Giakoumettis2, Abraham Tsitlakidis1
1Neurosurgery, KAT Attica General Hospital, Athens, GRC.
Cureus
|August 27, 2024
Summary
Spinal dural arteriovenous fistulae (sDAVFs) are rare and challenging. Surgery offers higher initial success rates for sDAVFs compared to embolization, though clinical outcomes may be similar. Treatment decisions depend on patient symptoms and contraindications.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Interventional Radiology
Background:
- Spinal dural arteriovenous fistulae (sDAVFs) are uncommon vascular malformations presenting diagnostic and therapeutic challenges.
- Delayed diagnosis of sDAVFs can lead to severe neurological deficits.
Observation:
- A systematic review and mini case series analyzed 3130 patients with sDAVFs diagnosed between 2014-2024.
- The thoracic spine was the most common location (65%).
- Surgery achieved a 98.1% initial occlusion rate, compared to 71.1% for embolization.
Findings:
- Surgery demonstrated superior initial fistula occlusion rates (98.1%) versus embolization (71.1%) for spinal dural arteriovenous fistulae.
- Despite differences in occlusion rates, no significant disparity in clinical outcomes was observed between surgical and endovascular treatments.
- Recurrence rates were notably lower after surgery (1.9%) than after embolization (9.6%).
Implications:
- Surgery is recommended as the primary treatment for sDAVFs due to higher initial success rates.
- Embolization may be considered for sDAVFs when contraindications for surgery exist.
- All symptomatic sDAVF patients warrant treatment; asymptomatic cases may be managed conservatively with close monitoring.
