Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography

Heui Seung Lee,Chun Kee Chung,Moon Hee Han,Hyun-Seung Kang,Seung Heon Yang,Sung Min Kim,Chi Heon Kim

doi:10.1038/s41598-021-89407-w

Abstract

Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. However, outcomes following further treatment with initial EVT are not well studied. We retrospectively reviewed 71 patients with SDAVF to evaluate treatment outcomes of SDAVF after an initial EVT attempt. Pretreatment and posttreatment functional states were assessed by the Aminoff-Logue scale (ALS). In the case of incomplete occlusion or recurrence, overall outcomes after further treatments were compared. Of the 71 patients, 56 underwent initial EVT. Complete occlusion was achieved by initial EVT in 37 of 56 patients (66.1%). Multiple feeders were more frequently observed in patients with incomplete occlusion than complete occlusion after initial EVT (73.7% vs. 27%, P < 0.001). Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. Functional improvement was not observed in patients who had repeated EVT or follow-up without further treatment. Recurrence was observed in 8 of 37 patients with complete occlusion upon initial EVT. Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up.

Highlights

Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment
To find the optimal individual treatment strategy for incomplete occlusion or recurrence by initial EVT, we reviewed all SDAVF patients treated in our hospital under the policy of an initial EVT attempt and elucidated factors associated with incomplete occlusion by initial EVT
The initial attempt of EVT was deemed infeasible in 15 patients for the following reasons: 6 had anterior spinal artery (ASA) or posterior spinal artery (PSA) originating from the SDAVF feeder, and 9 had arterial feeders that were too small for EVT

Summary

Introduction

Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up. The surgical outcome of spinal dural arteriovenous fistula (SDAVF) is excellent, with a success rate over 95%1–6, initial attempt of endovascular treatment (EVT) at the same session of diagnostic spinal angiography for spinal dural arteriovenous fistula (SDAVF) has become a preferred approach because of the benefit from concurrent diagnosis and treatment with a 70–90% rate of complete obliteration. We compared overall outcomes after further treatment in cases of incomplete occlusion or recurrence according to different treatment options after initial EVT. Abnormal gait or stance, but no restriction of activity Restricted activity Requiring 1 stick for walking Requiring 2 sticks, crutches, or walker Confined to wheelchair

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Discussion

Conclusion