Publication

Recurrence Rates After Surgical or Endovascular Treatment of Spinal Dural Arteriovenous Fistulas: A Meta-analysis

Bakker, N. A., Uyttenboogaart, M., Luijckx, G. J., Eshghi, O. S., Mazuri, A., Metzemaekers, J. D. M., Groen, R. J. M. & Van Dijk, J. M. C., Jul-2015, In : Neurosurgery. 77, 1, p. 137-144 8 p.

Research output: Contribution to journalReview articleAcademicpeer-review

BACKGROUND:There is an increasing tendency to treat spinal dural arteriovenous fistulas (SDAVFs) endovascularly despite the lack of clear evidence favoring embolization over surgery.OBJECTIVE:To compare the initial failure and recurrence rates of primary treatment of SDAVFs by surgery and endovascular techniques.METHODS:A meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standard was performed. All the English literature from 2004 onward was evaluated. From each article that compared the 2 treatment modalities, the odds ratio (OR) was calculated. Combined ORs were calculated with Review Manager 5.3 of The Cochrane Collaboration.RESULTS:A total of 35 studies harboring 1112 patients were assessed. Initial definitive fistula occlusion was observed in 588 of 609 surgical patients (96.6%; 95% confidence interval [CI], 94.8-97.8) vs 363 of 503 endovascularly treated patients (72.2%; 95% CI, 68.1-75.9; P <.001). The combined OR from 18 studies that assessed both treatment modalities (730 patients) was 6.15 (95% CI, 3.45-11.0) in favor of surgical treatment. Late recurrence (13 studies, 480 patients) revealed an OR of 3.15 (95% CI, 1.66-5.96; P <.001) in favor of surgery. In a subgroup, recurrence was reported in 10 of 22 patients (45%) treated with Onyx vs 8 of 35 (23%) treated with n-butyle-2-cyanoacrylate (OR, 2.51; 95% CI, 0.75-8.37; P = .13).CONCLUSION:Although hampered by inclusion of poor quality studies, this meta-analysis shows a definite advantage of primary surgical treatment of SDAVF over endovascular treatment in initial failure rate and late recurrences. The often-used argument that endovascular techniques have improved and therefore outweigh surgery is not supported by this meta-analysis.ABBREVIATIONS:CI, confidence intervalDSA, digital subtraction angiographyMeSH, Medical Subject HeadingsNBCA, n-butyl 2-cyanoacrylateOR, odds ratioPRISMA, Preferred Reporting Items for Systematic Reviews and Meta-AnalysesSDAVF, spinal dural arteriovenous fistula

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalNeurosurgery
Volume77
Issue number1
Publication statusPublished - Jul-2015

    Keywords

  • Endovascular techniques, Meta-analysis, Spinal DAVF, INDOCYANINE GREEN VIDEOANGIOGRAPHY, LONG-TERM, MULTIDISCIPLINARY TREATMENT, CLINICAL-EXPERIENCE, SINGLE-CENTER, MANAGEMENT, EMBOLIZATION, FEATURES, LOCALIZATION, ANGIOGRAPHY

ID: 17768916