Spinal Dural Arteriovenous Fistulas: Clinical and Radiological outcome of Endovascular Treatment

Background Data: Spinal dural arteriovenous fistulas are a rare entity that, if left untreated, can lead to considerable morbidity. Early diagnosis and effective methods of treatment are badly needed in clinical application. Purpose: To evaluate the clinical and radiological outcome of patients with spinal dural arteriovenous fistulas who were treated with endovascular embolization, with assessment of feasibility, safety and efficacy of endovascular treatment. Study Design: A retrospective clinical case study. Patients and Methods: A retrospective study was conducted on patients with Spinal Dural Arteriovenous Fistulas (SDAVFs) who underwent endovascular treatment in the period between February 2010 and February 2014 in the Departments of Neurosurgery in Ain Shams University, Cairo and Souhag University, Souhag, Egypt. Data were collected as regard clinical history, patient demographics, clinical presentation, neurologic examination, and diagnostic work-up, location of the fistula, duration of symptoms before diagnosis, treatment details, duration of follow-up, and the functional status (gait and micturition) (preoperative and postoperative). The study included twenty-two patients. Results: Age ranged from 39-69 years with a mean59.3 ± 9.7 years. There were 17 males (77.3%) and 5 females (22.7%). Clinical presentations at diagnosis included the following: lower extremity weakness was seen in 90.9%, sensory deficit symptoms in 72.7%, back pain in 50%, and urinary symptoms in 27.3%. The average duration of symptoms before treatment was 23.9 months. Six patients (27.7%) had a progressive stepwise worsening of symptoms. Endovascular treatment was successful in twenty patients (90.9%). There was 5% treatment-related complication. The mean interval follow up was 18 months. Recurrence occurred in two cases (10%) that needed further endovascular embolization without further morbidity. According to preprocedure and postprocedure Aminoff & Logue’s Scale of disability (ALS), improvement in gait was seen in 55% and, stabilization of gait in 45%, gait improvement was statistically significant, while Improvement in micturition disorder was seen in 25% and, stabilization in 75%, micturition disorder improvement was statistically insignificant. Conclusion: Endovascular embolization of SDAVF with cyanoacrylate glue was technically feasible in 90.9% of patients, relatively safe with low morbidity (5 % transient) and efficient with high favorable outcome, with statistically significant improvement in patients’ gait disability by almost one grade at follow-up, and micturition disorder improved in posttreatment follow up yet not statistically significant