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Comparison of Endovascular Embolization and Surgery in the Treatment of Spinal Intradural Dorsal Arteriovenous Fistulas

 Moo Sung Kang  ;  Kyung Hyun Kim  ;  Jeong Yoon Park  ;  Sung Uk Kuh  ;  Dong Kyu Chin  ;  Byung Ho Jin  ;  Yong Eun Cho  ;  Keun Su Kim 
 WORLD NEUROSURGERY, Vol.122 : e1519-e1527, 2019 
Journal Title
Issue Date
Adult ; Aged ; Arteriovenous Fistula/diagnostic imaging ; Arteriovenous Fistula/therapy ; Central Nervous System Vascular Malformations/diagnostic imaging ; Central Nervous System Vascular Malformations/therapy ; Embolization, Therapeutic ; Endovascular Procedures ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Spinal Cord/blood supply ; Spinal Cord/diagnostic imaging ; Treatment Outcome
Arteriovenous ;  Embolization ;  Endovascular ; Fistula ;  Intradural ;  Surgery
BACKGROUND: We compared the outcomes of endovascular embolization and surgery and investigated the factors affecting the clinical outcomes of spinal intradural dorsal arteriovenous fistulas (SIDAVFs). METHODS: The medical records of 26 patients who had undergone endovascular embolization or surgery for SIDAVFs from 2004 to 2014 were retrospectively reviewed. The recurrence rate and clinical outcomes for each treatment modality were compared. Multivariate analysis was used to identify significant factors influencing the clinical outcomes using the Aminoff and Logue (AL) score. RESULTS: Of the 26 patients, 14 (56%) had undergone endovascular embolization and 11 (44%) had undergone surgery as the initial treatment. Embolization was applied as the primary treatment for most patients. Surgery was chosen for patients with difficult superselection (n = 5), multiple feeders (n = 2), or easy surgical accessibility (n = 4). Of the 14 patients who had undergone embolization as initial treatment, 5 (36%) had developed a recurrence within an average of 29.6 months (range, 2-87). One patient with recurrent SIDAVF was treated with repeat embolization and four with surgery. None of patients in the surgical group developed recurrence. Embolization as the initial treatment resulted in significantly greater recurrence compared with surgery (odds ratio, 2.222; 95% confidence interval, 1.369-3.608; P = 0.046). Surgery resulted in better clinical outcomes than embolization (P = 0.021). The final AL score was also strongly affected by the preoperative AL score, micturition score, and recurrence (P = 0.000, P = 0.000, and P = 0.011, respectively). CONCLUSIONS: Our results have shown that surgery results in a low recurrence rate and superior clinical outcomes. A multidisciplinary and ordered decision is crucial for the treatment choice to ensure better outcomes, especially for patients with a definite neurologic deficit at diagnosis.
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1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kuh, Sung Uk(구성욱) ORCID logo https://orcid.org/0000-0003-2566-3209
Kim, Kyung Hyun(김경현)
Kim, Keun Su(김근수) ORCID logo https://orcid.org/0000-0002-3384-5638
Park, Jeong Yoon(박정윤) ORCID logo https://orcid.org/0000-0002-3728-7784
Cho, Yong Eun(조용은) ORCID logo https://orcid.org/0000-0001-9815-2720
Chin, Dong Kyu(진동규) ORCID logo https://orcid.org/0000-0002-9835-9294
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