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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 22:40-47 (1 2001)
© 2001 American Society of Neuroradiology

ARTICLE

N-butyl 2-cyanoacrylate Embolization of Spinal Dural Arteriovenous Fistulae

Joon K. Song^a, Y. Pierre Gobin^a, Gary R. Duckwiler^a, Yuichi Murayama^a, John G. Frazee^a, Neil A. Martin^a and Fernando Viñuela^,a

^a From the Division of Interventional Neuroradiology, Department of Radiology (J.K.S., Y.P.G., G.R.D., Y.M., F.V.), and Section of Neurovascular Surgery (J.G.F., N.A.M.), Division of Neurosurgery, Department of Surgery, University of California at Los Angeles School of Medicine, Los Angeles, CA.

BACKGROUND AND PURPOSE: Because they are not well established, we investigated the technical success and recurrence rates of n-butyl 2-cyanoacrylate (NBCA) embolization of spinal dural arteriovenous fistulae (SDAVF), and assessed clinical outcomes.

METHODS: We retrospectively studied all patients with SDAVF treated by NBCA embolization at our institution over an 8-year period. Gait and micturition disabilities were analyzed. Follow-up periods averaged 3.1 years (range, 1 month to 8.9 years).

RESULTS: NBCA embolization was feasible in 74% (20/27) of patients. Of 20 patients who underwent embolization, initial embolization failure occurred in two (10%) and fistula occurrence in three (15%). All five patients in whom NBCA embolization failed underwent surgery. All patients who underwent embolization had either improved (55%) or unchanged (45%) gait disability at last follow-up. Seventeen (85%) patients had improved (40%) or unchanged (45%) micturition disability, but three (15%) had worsened. Mean Aminoff gait disability grade significantly decreased at last follow-up (2.4 [1.4] average [SD] vs 3.2 [1.4] [P = .0008]). Mean micturition disability grade decreased, but not significantly (1.4 [1.0] vs 1.7 [1.1] [P = .28]).

CONCLUSION: NBCA embolization of SDAVF was technically feasible in 75% of patients. Initial apparent successful embolization was achieved in 90%; the fistula recurrence rate (failure to occlude the draining vein) for NBCA was 15%. Comparing favorably to surgical series, NBCA embolization of SDAVF appears efficacious, significantly improving mean gait disability by almost one grade at last follow-up. Close clinical and angiographic surveillance is mandatory. Longer and more uniform follow-up is needed to determine if clinical improvement and stabilization after NBCA embolization are sustained.

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