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Endovascular Embolization of Spinal Dural AVF and AVM: A Trans-Atlantic Two Institution Experience 2012

Interventional Spine

Augusto, E, Elias, DDS, MD
Neeraj, Chaudhary, MD MRCS FRCR, Non ASSR Member
Aditya, S, Pandey, MD, Non ASSR Member
Stefan, Brew, FRANZCR, Non ASSR Member
John, J, Gemmete, MD, Non ASSR Member

Paper/Mentor

Purpose

The aim of this study is to characterize the clinical presentation, imaging diagnosis, and outcome of patients diagnosed with spinal vascular malformations treated with endovascular embolization and surgical resection at two quaternary referral centers on two sides of the Atlantic (Ann Arbor, Michigan, USA & Queen Square, London, UK), with specific attention to our preliminary experience at endovascular embolization utilizing Onyx.

Methods & Materials

A retrospective analysis of medical records including patient charts, outpatient and operative notes and clinical follow up accounts was performed at two academic quaternary referral university hospitals from 2004-2010 (Hospital A - USA) and 1997-2006 (Hospital B - UK) following local institutional review board approval.

Results

Hospital A: 21 patients; 6 endovasculary with Onyx (28%), 7 with glue (38%), 7 surgically (38%) and 1 not treated. Mean follow up 3 months range (3 days - 2 years). Mean improvement in the Aminoff-Logue scale (ALS) including gait and micturition in the Onyx group was 5 (83%), in the n-BCA treatment group was 4 (57%) and in the surgical group was 3 (43%). Hospital B: 22 patients; data available for analysis in 13 patients; 9 endovascularly and 4 surgically. Further analysis was available in 10 patients; 9 - n-BCA and 1 surgery. Mean follow up 19 months (range 3 days - 10 years). Based on pre and post procedure ALS, available in 8 patients, mean improvement was 37%.

Conclusion

Our experience with endovascular treatment of SDAVF demonstrates safety and efficacy of this technique. It lends support to the existing literature demonstrating the feasibility of utilization of Onyx as an alternative liquid embolic agent.

References/Financial Disclosures

1. Borden, J.A., J.K. Wu, and W.A. Shucart, A proposed classification for spinal and cranial dural arteriovenous fistulous malformations and implications for treatment. J Neurosurg, 1995. 82(2): p. 166-79. 2. Anson, J.A. and R.F. Spetzler, Interventional neuroradiology for spinal pathology. Clin Neurosurg, 1992. 39: p. 388-417. 3. Patsalides, A., et al., Endovascular treatment of spinal arteriovenous lesions: beyond the dural fistula. AJNR Am J Neuroradiol, 2011. 32(5): p. 798-808. 4. Nogueira, R.G., et al., Onyx embolization for the treatment of spinal dural arteriovenous fistulae: initial experience with long-term follow-up. Technical case report. Neurosurgery, 2009. 64(1): p. E197-8; discussion E198. 5. Song, J.K., et al., Surgical and endovascular treatment of spinal dural arteriovenous fistulas: long-term disability assessment and prognostic factors. J Neurosurg, 2001. 94(2 Suppl): p. 199-204.

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