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Results favor primary surgery for spinal dural arteriovenous fistulas
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According to published study results, surgery appeared to be more effective than endovascular techniques to treat spinal dural arteriovenous fistulas.
Researchers conducted a meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, which included 35 studies that involved 1,112 patients.
Definitive spinal dural fistula occlusion was observed in 588 of 609 surgical patients vs. 363 of 503 patients who underwent endovascular treatment with either n-butyl 2-cyanoacrylate or Onyx (Covidien).
The primary outcome used was failure of the initial treatment or recurrence of the fistula and failure occurred in 21 patients who underwent surgery for a successful treatment rate of 96.6% (95% CI). In all 140 patients who underwent endovascular treatment were treated successfully for a succes rate of 72.2% (95% CI; P < .001).
The overall studies were of poor quality as they were all retrospectively based, the researchers noted. Despite that, they concluded surgery has an advantage in treatment of spinal dural arteriovenous fistulas over endovascular treatment in terms of initial treatment success and fistula recurrence. – by Robert Linnehan
Disclosure: The researchers report no relevant financial disclosures.
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