Vergleichen der extraduralen radikulären Gefäßligatur mit dem intraduralen Gefäßverschluss bei der Behandlung SDAVF. Erfahrung mit 18 Eingriffen.

The goal of SDAVF treatment is a permanent fistula interruption. Simply microsurgical intradural occlusion of the proximal arterialized draining vein has become a well-accepted treatment option. Other technique modifications with extradural fistula occlusion at the level of accompanying nerve root are lacking in the literature. This report discusses the experiences with the surgical treatment of SDAVF, focusing on comparing the effectiveness of intradural and extradural radicular vessel ligation.

A retrospective analysis of all patients undergoing microsurgical occlusion of SDAVF from 05/2011 – 05/2022 in the author"s department was performed. Clinical, radiological, and intraoperative data were evaluated. All patients with SDAVF treated surgically were analyzed. Special attention has been given to providing insights into surgical technique, and comparison of effectiveness of intra- and extradural SDAVF occlusion.

In total, 18 microsurgical SDAVF occlusions were performed in 14 patients (three female and eleven male patients, mean age 62,14 years, age range 28-83 years). Most commonly, the SDAVF was localized in the thoracal region (72.2%). Progressive motor deficits and gait ataxia were the most common clinical manifestations (71.4%). Simply microsurgical intradural SDAVF interruption was considered in 10 procedures (55.5%), and extradural radicular vessel ligation with intradural fistula occlusion in 7 procedures (38.8%). In one case, an extradural radicular vessel occlusion was solely performed. There were no intraoperative complications. There were no differences in the clinical outcome directly postoperatively. However, a significantly better outcome was observed for gait ataxia in SDAVF patients treated with concomitant intra- and extradural radicular vessel ligation in 6 months follow-up, ( p= 0,0441). Successful surgical occlusion of SDAVF was achieved in 94.4%. The mean follow-up period was 13.23 months (range, 1–57 months).

Microsurgical occlusion of SDAVF is an effective, and low complication rate first-line treatment option for SDAVF. A concomitant extradural radicular vessel ligation, close to the fistula point, offers proximal fistula disconnection, minimizes the risk of incomplete fistula occlusion, and avoids the formation of new arteriovenous shunt vessel recruitment. Intradural inspection adds to a high occlusion rate. Satisfactory outcomes of selected neurologic deficits can be achieved.