Treatment of spinal dural arteriovenous malformations: a single center
experience.

RH Andres, R Guzman, L Remonda, G Schroth, RW Seiler and A Barth
Departments of Neurosurgery and Neuroradiology, University of Berne, Switzerland.
E-mail: robert.andres@hispeed.ch, robert.andres@neurochirurgie-bern.ch

AIM: Spinal dural arteriovenous malformation is the most common type of arteriovenous malformations (AVM) involving the spine, usually presenting with a slowly progressive myelopathy and/or radiculopathy. The management of these rare lesions either consists of catheter embolization or surgical intradural interruption of the draining vessel. The decision between these techniques is often controversial. The present study assessed the outcome of patients with spinal AVMs that were treated with surgery, endovascular embolization or a combined treatment strategy. METHODS: Our series consisted of 12 patients with dural AVMs of the thoracic or lumbar spine that were treated in our institution between 1994 and 2004. Six patients were treated with embolization alone. Three patients underwent laminectomy and surgical interruption of the AVM. Three patients were treated by endovascular techniques followed by surgery. Patient age ranged from 20 to 76 years (mean 59 years). Functional outcome was assessed using the modified Aminoff-Logue grading scale with a mean follow-up of 6 months. RESULTS: The 3 patients who had underwent surgery had successful occlusion of the AVM and had marked clinical improvement. Of the 6 patients who had only endovascular treatment 4 of them had successful occlusion and clinical improvement; the other 2 patients required re-embolization in a second session due to extensive fistulas. Two of the 3 patients with extensive lesions who were first treated endovascularly followed by surgery had good outcome. CONCLUSIONS: We conclude that both surgical and endovasular treatment of spinal dural AVMs resulted in a good and lasting clinical outcome in the majority of cases. Embolization should be attempted at the time of diagnostic angiography if the lesion is endovascularly accessible. An interdisciplinary approach is often necessary to address the technical complexity of this rare disorder.

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