[Endovascular surgery of spinal dural arteriovenous fistulas]. / Éndovaskuliarnaia khirurgiia dural'nykh arteriovenoznykh fistul spinnogo mozga.

ABSTRACT

The article summarizes the experience in the treatment of spinal dural arteriovenous fistulas (SDAVFs). OBJECTIVE: To evaluate the efficacy of endovascular treatment of SDAVFs, depending on the pathophysiological mechanisms of impact on the spinal cord. MATERIAL AND METHODS: For the last 5 years (2013-2017), 302 patients with SDAVFs were diagnosed and treated at the Neurosurgical Institute. The endovascular technique was used in 295 patients with this pathology. Males accounted for 82%; females accounted for 18%; the mean age was 51 years. Magnetic resonance imaging (MRI) was used to assess the degree of spinal cord involvement. All SDAVF patients underwent total selective spinal angiography in order to study angioarchitectonics and to choose an endovascular treatment option. RESULTS AND CONCLUSION: Endovascular embolization of fistulas was performed in 295 out of 302 patients; direct surgery was used in the remaining cases. Endovascular treatment provided total SDAVF occlusion in 78% of cases and partial SDAVF occlusion in 22% of cases. Long-term outcomes were followed-up in all patients in a period of 6 to 12 months. In 90% of cases, improvement or stabilization of neurological symptoms was observed. In 60% of cases, there was a marked improvement in the neurological status in the form of rapid (within a few days) recovery of lost motor functions. The remaining patients had stabilization of clinical symptoms.