Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center
Background: Spinal dural arteriovenous fistula (SDAVF) is a rare disease with insidious clinical manifestations that can often be overlooked on initial examination. Our aim was to identify predictive factors associated with favorable long-term outcomes and to compare the clinical results between sur...
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Elsevier
2025-01-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529425001547 |
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| author | Mido Max Hijazi Andreas Filis Penelope Felgenhauer Kay Engellandt Sergio M.F. Romualdo Dino Podlesek Tareq A. Juratli Ilker Y. Eyüpoglu |
| author_facet | Mido Max Hijazi Andreas Filis Penelope Felgenhauer Kay Engellandt Sergio M.F. Romualdo Dino Podlesek Tareq A. Juratli Ilker Y. Eyüpoglu |
| author_sort | Mido Max Hijazi |
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| description | Background: Spinal dural arteriovenous fistula (SDAVF) is a rare disease with insidious clinical manifestations that can often be overlooked on initial examination. Our aim was to identify predictive factors associated with favorable long-term outcomes and to compare the clinical results between surgical and endovascular treatment. Methods: A retrospective chart review was conducted of 81 patients with SDAVF who underwent either surgical (n = 70, 86.4 %) or endovascular (n = 11, 13.6 %) treatment at our hospital between 2002 and 2023, with a mean follow-up duration of 22.4 months. Results: A significantly greater proportion of surgical (S) patients (45/70, 64.3 %) showed improvement in the modified Aminoff and Logue Scale (mALS) between admission and last follow-up compared to endovascular (E) patients (3/11, 27.3 %; p = 0.043). There were no significant differences between the two groups over the clinical course (preoperative, postoperative, first, second, and third follow-up) in terms of mALS, American Spinal Injury Association Motor Score (ASIA-MS), back pain, or sensory disturbances. Incomplete or failed fistula closure occurred significantly more frequently in the endovascular group than in the surgical group (S: 3/70, 4.3 % vs. E: 5/11, 45.5 %, p < 0.001). The time interval between MRI-based diagnosis and treatment was identified as an independent predictor of long-term mALS improvement in the multivariate logistic regression analysis (0.978 (0.959–0.997), p = 0.026). Conclusions: Surgical treatment of SDAVF is generally safe and effective and shows superior outcomes compared to endovascular treatment; however, endovascular therapy remains an important option in special cases. Moreover, the time interval between MRI-based diagnosis and surgical or endovascular treatment plays a critical role in determining long-term clinical outcomes of SDAVF patients. |
| format | Article |
| id | doaj-art-b91ebf6bca7e4416b4246c50326a0841 |
| institution | DOAJ |
| issn | 2772-5294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-b91ebf6bca7e4416b4246c50326a08412025-08-20T03:08:52ZengElsevierBrain and Spine2772-52942025-01-01510433510.1016/j.bas.2025.104335Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine centerMido Max Hijazi0Andreas Filis1Penelope Felgenhauer2Kay Engellandt3Sergio M.F. Romualdo4Dino Podlesek5Tareq A. Juratli6Ilker Y. Eyüpoglu7Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany; Corresponding author. Department of Neurosurgery University Hospital Carl Gustav Carus, Fetscherstr. 74 01307, Dresden. Germany.Department of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyInstitute of Diagnostic and Interventional Neuroradiology, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyDepartment of Neurosurgery, Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, GermanyBackground: Spinal dural arteriovenous fistula (SDAVF) is a rare disease with insidious clinical manifestations that can often be overlooked on initial examination. Our aim was to identify predictive factors associated with favorable long-term outcomes and to compare the clinical results between surgical and endovascular treatment. Methods: A retrospective chart review was conducted of 81 patients with SDAVF who underwent either surgical (n = 70, 86.4 %) or endovascular (n = 11, 13.6 %) treatment at our hospital between 2002 and 2023, with a mean follow-up duration of 22.4 months. Results: A significantly greater proportion of surgical (S) patients (45/70, 64.3 %) showed improvement in the modified Aminoff and Logue Scale (mALS) between admission and last follow-up compared to endovascular (E) patients (3/11, 27.3 %; p = 0.043). There were no significant differences between the two groups over the clinical course (preoperative, postoperative, first, second, and third follow-up) in terms of mALS, American Spinal Injury Association Motor Score (ASIA-MS), back pain, or sensory disturbances. Incomplete or failed fistula closure occurred significantly more frequently in the endovascular group than in the surgical group (S: 3/70, 4.3 % vs. E: 5/11, 45.5 %, p < 0.001). The time interval between MRI-based diagnosis and treatment was identified as an independent predictor of long-term mALS improvement in the multivariate logistic regression analysis (0.978 (0.959–0.997), p = 0.026). Conclusions: Surgical treatment of SDAVF is generally safe and effective and shows superior outcomes compared to endovascular treatment; however, endovascular therapy remains an important option in special cases. Moreover, the time interval between MRI-based diagnosis and surgical or endovascular treatment plays a critical role in determining long-term clinical outcomes of SDAVF patients.http://www.sciencedirect.com/science/article/pii/S2772529425001547SDAVFSpinal arteriovenous fistulaMyelopathyEndovascular treatmentSurgical treatmentSpinal cord edema |
| spellingShingle | Mido Max Hijazi Andreas Filis Penelope Felgenhauer Kay Engellandt Sergio M.F. Romualdo Dino Podlesek Tareq A. Juratli Ilker Y. Eyüpoglu Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center Brain and Spine SDAVF Spinal arteriovenous fistula Myelopathy Endovascular treatment Surgical treatment Spinal cord edema |
| title | Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center |
| title_full | Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center |
| title_fullStr | Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center |
| title_full_unstemmed | Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center |
| title_short | Predictive factors and comparative analysis of surgical vs. endovascular treatment for spinal dural arteriovenous fistulas: a 22-year experience at a neurovascular and spine center |
| title_sort | predictive factors and comparative analysis of surgical vs endovascular treatment for spinal dural arteriovenous fistulas a 22 year experience at a neurovascular and spine center |
| topic | SDAVF Spinal arteriovenous fistula Myelopathy Endovascular treatment Surgical treatment Spinal cord edema |
| url | http://www.sciencedirect.com/science/article/pii/S2772529425001547 |
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