• Maxime Bretonnier, Pierre-Louis Hénaux, Thomas Gaberel, Vincent Roualdes, Gaelle Kerdiles, Pierre-Jean Le Reste, and Xavier Morandi.
• Department of Neurosurgery, Rennes University Hospital, Rennes, France; University of Rennes, University Hospital of Rennes, French National Institute of Health and Medical Research, Rennes, France. Electronic address: maxime.bretonnier@chu-rennes.fr.
• World Neurosurg. 2019 Jul 1; 127: e943-e949.

ObjectiveSpinal dural arteriovenous fistulas (SDAVFs) are rare vascular spinal malformations. According to the reported data, surgery seems to result in better occlusion rates than endovascular treatment. However, the post-treatment evolution of neurological symptoms stratified by the treatment remains unknown. The main objective of the present study was to compare the clinical outcomes for patients according to the treatment method.MethodsThe data from 63 patients with SDAVFs from 2000 to 2017 at 4 academic neurosurgical departments were retrospectively analyzed. Preoperative and postoperative examination neurological status was assessed using the Aminoff-Logue scale (ALS), which evaluates gait and micturition disturbances. Initial occlusion, late recurrence, and complications of the 2 techniques were also reviewed.ResultsPatients who had undergone surgery and embolization improved clinically on the ALS (P = 0.0009), and no significant differences were found between the 2 techniques. Subgroup analysis using the ALS showed that patients who had undergone surgery and embolization without late recurrence improved (P < 0.0001 and P = 0.0334, respectively) and that patients who had undergone surgery or embolization with late recurrence did not improve. The initial occlusion rate was in favor of surgery, with 91.3% versus 70% for endovascular treatment (P = 0.050). The late recurrence rate was higher for embolization (21.4% vs. 9.1% for surgery; P = 0.28).ConclusionsSurgery can be proposed as first-line treatment of SDAVFs after multidisciplinary discussion between neurosurgeons and neuroradiologists. The development of late recurrence negatively affects the neurological outcome of patients.Copyright © 2019 Elsevier Inc. All rights reserved.

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