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

被引：14

作者：

Takai, Keisuke ^{[8
]}

Endo, Toshiki ^{[2
]}

Yasuhara, Takao ^{[13
]}

Seki, Toshitaka ^{[1
]}

Watanabe, Kei ^{[3
]}

Tanaka, Yuki ^{[3
]}

Kurokawa, Ryu ^{[4
]}

Kanaya, Hideaki ^{[4
]}

Honda, Fumiaki ^{[5
]}

Itabashi, Takashi ^{[6
]}

Ishikawa, Osamu ^{[7
]}

Murata, Hidetoshi ^{[9
]}

Tanaka, Takahiro ^{[9
]}

Nishimura, Yusuke ^{[10
]}

Eguchi, Kaoru ^{[10
]}

Takami, Toshihiro ^{[11
]}

Watanabe, Yusuke ^{[11
]}

Nishida, Takeo ^{[12
]}

Hiramatsu, Masafumi ^{[13
]}

Ohtonari, Tatsuya ^{[14
]}

Yamaguchi, Satoshi ^{[15
]}

Mitsuhara, Takafumi ^{[15
]}

Matsui, Seishi ^{[16
]}

Uchikado, Hisaaki ^{[17
]}

Hattori, Gohsuke ^{[17
]}

Yamahata, Hitoshi ^{[18
]}

Taniguchi, Makoto ^{[8
]}

机构：

[1] Hokkaido Univ Hosp, Dept Neurosurg, Sapporo, Hokkaido, Japan

[2] Kohnan Hosp, Dept Neurosurg, Sendai, Miyagi, Japan

[3] Niigata Univ Med & Dent Hosp, Dept Orthopaed Surg, Niigata, Japan

[4] Dokkyo Med Univ Hosp, Dept Neurosurg, Mibu, Tochigi, Japan

[5] Gunma Univ Hosp, Dept Neurosurg, Gunma, Japan

[6] Japanese Red Cross Narita Hosp, Dept Orthopaed Surg, Chiba, Japan

[7] Univ Tokyo Hosp, Dept Neurosurg, Tokyo, Japan

[8] Tokyo Metropolitan Neurol Hosp, Dept Neurosurg, Tokyo, Japan

[9] Yokohama City Univ Med, Dept Neurosurg, Yokohama, Kanagawa, Japan

[10] Nagoya Univ Hosp, Dept Neurosurg, Nagoya, Aichi, Japan

[11] Osaka City Univ, Dept Neurosurg, Grad Sch Med, Osaka, Japan

[12] Osaka Univ, Dept Neurosurg, Grad Sch Med, Osaka, Japan

[13] Okayama Univ, Dept Neurosurg, Grad Sch Med, Okayama, Japan

[14] Ota Mem Hosp, Brain Attack Ctr, Dept Spinal Surg, Hiroshima, Japan

[15] Hiroshima Univ Hosp, Dept Neurosurg, Hiroshima, Japan

[16] Ehime Univ Hosp, Dept Neurosurg, Toon, Ehime, Japan

[17] Kurume Univ Hosp, Dept Neurosurg, Fukuoka, Japan

[18] Kagoshima Univ Hosp, Dept Neurosurg, Kagoshima, Japan

来源：

JOURNAL OF NEUROSURGERY-SPINE | 2021年 / 34卷 / 03期

关键词：

spinal vascular malformations; spinal arteriovenous shunts; dural arteriovenous shunts; surgery; endovascular embolization; vascular disorders; INTERRUPTION;

D O I：

10.3171/2020.6.SPINE20309

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：514 / 521

页数：8

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