Spinal dural arteriovenous fistulae: Treatments and outcomes a systematic review and meta-analysis

The objective was to explore factors associated with early outcomes in patients with spinal dural arteriovenous fistulae (sDAVF) treated by open surgery (Open) or endovascular procedures (Endo).

Data sources: MEDLINE, Web of Science, and Ovid to March 9, 2024. Study selection: adult sDAVF cohorts with ≥11 patients reporting on at least one of the outcomes of interest. Data extraction and synthesis: PRISMA guidelines were used to screen studies/extract data. Fistula closure rates, complication rates, and prevalence of the affected spine segments were analysed based on summary data. The post- vs. pre-procedural difference in clinical disability was based on individual patient data. Main Outcome(s) and Measure(s): (1) fistula closure rate; (2) early complications rate; (3) clinical disability; (4) prevalence of sDAVF across spine segments/levels.

We identified 115 cohorts. Odds of closure (106 reports on Open, 82 on Endo, adjusted for covariates) were higher with Open vs. Endo (OR = 7.68, 95%CI 5.48-11.0). Odds of complications (59 reports on Open, 48 on Endo, adjusted) were similar for Open vs. Endo (OR = 1.02, 0.77-1.35, prediction 0.77-1.35). With adjustment (21 reports with individual patient data, 288 Open and 134 Endo procedures), reduction in disability scores was larger with Open vs. Endo (difference= -0.55, 95%CI -0.95, -0.15), consistently across the spinal segments, age, and sex. All estimates were resistant to bias (E-values = 4.99, 2.00, and 2.70).

Compared to Endo, Open is more likely to result in fistula closure and reduction of disability, with a similar probability of complications.