Andrew Wu MD, Presenter: Nothing to Disclose

Minako Hayakawa MD, Abstract Co-Author: Nothing to Disclose

Coleman Martin MD, Abstract Co-Author: Nothing to Disclose

John Christopher Chaloupka MD, Abstract Co-Author: Consultant, Boston Scientific Corporation Consultant, Johnson & Johnson (Cordis Corporation) Consultant, Micrus Corp Consultant, ev3 Inc

To evaluate the safety, efficacy and complications of endovascular surgery as the sole treatment modality for intracranial and spinal dural arteriovenous fistulas.

Retrospective chart review was performed for patients who underwent endovascular treatment for DAVF at our institution from 1/1/2005 to 3/31/2007. Thirty-nine patients were found, ages 0-87 (mean 56), with 40 DAVFs: 34 intracranial and 6 spinal. Cognard classifications of the intracranial DAVFs include 11 type II, 22 type III and 1 type IV. Data analyzed include approach (transarterial or transvenous), technique (glue, coil, ethanol, balloon), number of embolizations performed, number of sessions required, clinical outcome, angiographic outcome and complications. Pearson chi-square test was used to determine if there was a correlation between the type of DAVF and complications.

Transarterial, transvenous and combined (both) embolizations were performed in 29 (74%), 7 (18%), and 3 (8%) patients, respectively, requiring between 1 to 4 treatment sessions each. Angiographic cure was achieved in 32 (82%) patients. Of the remaining, 2 (5%) have achieved clinical cure and are managed conservatively, and 5 (13%) are awaiting further staged intervention. Complications resulting in permanent neurologic sequelae occurred in 2 (5%) patients, one major and one minor. Six (15%) patients suffered complications with transient symptoms and subsequent full recovery. No statistically significant correlation was found between type of DAVF and incidence of complications.

Endovascular surgery is safe and effective as the sole therapeutic modality for spinal and intracranial dural arteriovenous fistulas.

Endovascular surgery may be used as the sole modality for curative therapy and palliative care of DAVFs and should be given strong consideration when evaluating potential treatment options.

Wu, A, Hayakawa, M, Martin, C, Chaloupka, J, Endovascular Surgery as Sole Therapeutic Modality for Intracranial and Spinal Dural Arteriovenous Fistulas: Technique, Outcome, and Complications in Thirty-Nine Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5012455.html