Comparative Efficacy and Safety of Endovascular vs. Surgical Treatment in Spinal Dural Arteriovenous Fistulas: A Systematic Review and Meta-Analysis.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY

Spine Pub Date : 2025-01-21 DOI:10.1097/BRS.0000000000005226

Basel Musmar, Joanna M Roy, Atakan Orscelik, Sonu Bhaskar, Saman Sizdahkhani, Elias Atallah, Sravanthi Koduri, Stavropoula I Tjoumakaris, Michael Reid Gooch, Robert H Rosenwasser, Pascal Jabbour

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Abstract

Study design: Systematic Review and Meta-analysis.

Objective: This study aims to compare the efficacy and safety of surgical and endovascular treatments for SDAVFs.

Summary of background data: Spinal dural arteriovenous fistulas (SDAVFs) result from an abnormal connection between the radiculomeningeal artery and the radicular vein, leading to venous hypertension and potential neurological damage. The two primary treatment strategies are surgical closure and endovascular obliteration of the fistula.

Methods: PubMed, Scopus, and Web of Science databases were searched from inception to July 2024. We defined the successful treatment as fistula occlusion with sufficient embolic material penetration or obliteration during surgery.

Results: A total of 1192 articles were identified, with 40 studies meeting the inclusion criteria, comprising 1818 patients (surgical: 804, endovascular: 1014). The surgical group demonstrated higher rates of complete occlusion at last follow-up (96.8%, 363/375) compared to the endovascular group (72.5%, 470/648) (OR: 0.16; CI: 0.09 to 0.28, P<0.01). Surgical treatment also had higher successful treatment rates (97.5%, 392/402) compared to endovascular treatment (66.7%, 529/793) (OR: 0.11; CI: 0.06 to 0.19, P<0.01). Recurrence rates were lower in the surgical group (OR: 6.04; CI: 3.45 to 10.57, P<0.01) and retreatment rates were also lower (OR: 7.16; CI: 4.11 to 12.48, P<0.01). Initial treatment failure was significantly higher in the endovascular group (32.2%, 329/1023) compared to the surgical group (2.3%, 19/804) (OR: 8.97; CI: 5.56 to 14.45, P<0.01).

Conclusions: Surgical treatment for SDAVFs achieves higher rates of complete occlusion and successful treatment compared to endovascular treatment, with lower rates of recurrence, retreatment, and initial treatment failure. Although both treatments show similar improvements in neurological status and periprocedural complications, surgery remains the preferred approach for definitive results. Treatment decisions should be individualized based on patient-specific factors and anatomical characteristics. Further research is needed to confirm these results.

查看原文本刊更多论文

血管内与手术治疗硬脊膜动静脉瘘的疗效和安全性比较：系统回顾和荟萃分析。

研究设计：系统评价和荟萃分析。目的：比较手术和血管内治疗sdavf的疗效和安全性。背景资料总结：脊膜动静脉瘘（SDAVFs）是由脊膜根动脉和根静脉之间的异常连接引起的，可导致静脉高压和潜在的神经损伤。两种主要的治疗策略是手术闭合和血管内封堵瘘。方法：检索PubMed、Scopus和Web of Science数据库，检索时间为建站至2024年7月。我们将成功的治疗定义为在手术中有足够的栓塞材料穿透或封堵瘘管。结果：共纳入1192篇文献，其中40项研究符合纳入标准，包括1818例患者（外科：804例，血管内：1014例）。在最后一次随访中，手术组的完全闭塞率（96.8%,363/375）高于血管内组（72.5%,470/648）(OR: 0.16；结论：与血管内治疗相比，手术治疗SDAVFs的完全闭塞率和治疗成功率更高，复发率、再治疗率和初始治疗失败率更低。尽管两种治疗方法在神经系统状况和术中并发症方面表现出相似的改善，但手术仍然是确定结果的首选方法。治疗决定应根据患者的具体因素和解剖特征进行个体化。需要进一步的研究来证实这些结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.