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Clinical outcomes following microsurgery and endovascular embolization in the management of spinal dural arteriovenous fistula: A meta-analysis study
Received date: 2020-02-12
Online published: 2022-04-13
Supported by
National Natural Science Foundation of China(81541119);Peking University First Hospital Cross Clinical Study Foundation;Youth Clinical Research Project of Peking University First Hospital(2019CR02)
Objective: To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis. Methods: A systematic review was performed to retrieve all relevant literature about surgical treatment or endovascular embolization of SDAVF up to December 2019 through PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials Results, CNKI, Wanfang Data, and SinoMed. The Chinese and English key words included: “SDAVF”, “spinal dural arteriovenous fistula”, “spinal AVM”, “spinal vascular malformation and treatment”. The included studies were evaluated using the Newcastle-Ottawa scale. The early failure rate, long-term recurrence, neurological recovery, and complications were evaluated and the clinical effects of the two methods in the treatment of SDAVF were compared by using RevMan 5.3 software. And a further subgroup analysis of the therapeutic effect of endovascular embolization with different embolic agents was conducted. Results: A total of 46 studies involving 1 958 cases of SDAVF were included, in which 935 cases were treated by microsurgery and 1 023 cases were treated by endovascular embolization. The funnel plot demonstrated that there was no publication bias. The results of meta-analysis showed that the incidence of early surgical failure was lower than that of endovascular embolization (OR=0.20, 95%CI: 0.13-0.30, P<0.05), and the long-term recurrence was also lower than that of endovascular embolization (OR=0.36, 95%CI: 0.22-0.58, P<0.05). The improvement of neurological function in the surgical patients is significantly higher than that in the patients treated with endovascular embolization (OR=2.86, 95%CI: 1.36-5.99, P<0.05). There was no significant difference in the occurrence of complications in these two groups (OR=1.52, 95%CI: 0.88-2.64, P=0.14). In the cases of endovascular embolization, the risk of treatment failure or recurrence was higher with Onyx glue than with n-butyl 2-cyanoacrylate (NBCA), and the difference was statistically significant (OR=4.70, 95%CI: 1.55-14.28, P<0.05). Conclusion: Although the treatment of dural arteriovenous fistulas by intravascular embolization has been widely used, the clinical effect of microsurgery is still better than that of endovascular embolization. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of endovascular treatment in SDAVF patients.
Key words： Dura mater; Arteriovenous fistula; Microsurgery; Embolization; therapeutic; Meta-analysis
Chang-wei YUAN , Ying-jin WANG , Shu-jie ZHANG , Sheng-li SHEN , Hong-zhou DUAN . Clinical outcomes following microsurgery and endovascular embolization in the management of spinal dural arteriovenous fistula: A meta-analysis study[J]. Journal of Peking University(Health Sciences), 2022 , 54(2) : 304 -314 . DOI: 10.19723/j.issn.1671-167X.2022.02.018
| [1] | 马廉亭, 龚杰, 樊光辉, 等. 脊髓静脉高压综合征的诊断治疗策略与方法[J]. 中华神经外科志, 2010, 26(11):1007-1009. |
| [2] | 王刚, 佟志勇, 刘源, 等. 硬脊膜动静脉瘘的临床特点和治疗现状[J]. 医学综述, 2018, 24(3):527-532. |
| [3] | Brinjikji W, Nasr DM, Morris JM, et al. Clinical outcomes of patients with delayed diagnosis of spinal dural arteriovenous fistulas[J]. AJNR Am J Neuroradiol, 2016, 37(2):380-386. |
| [4] | Aminoff MJ, Logue V. The prognosis of patients with spinal vascular malformations[J]. Brain, 1974, 97(1):211-218. |
| [5] | Ushikoshi S, Hida K, Kikuchi Y, et al. Functional prognosis after treatment of spinal dural arteriovenous fistulas[J]. Neurol Med Chir (Tokyo), 1999, 39(3):206-213. |
| [6] | Song JK, Vinuela F, Gobin YP, et al. Surgical and endovascular treatment of spinal dural arteriovenous fistulas: Long-term disability assessment and prognostic factors[J]. J Neurosurg, 2001, 94(2 Suppl):199-204. |
| [7] | Jellema K, Sluzewski M, van Rooij WJ, et al. Embolization of spinal dural arteriovenous fistulas: Importance of occlusion of the draining vein[J]. J Neurosurg Spine, 2005, 2(5):580-583. |
| [8] | Andres RH, Barth A, Guzman R, et al. Endovascular and surgical treatment of spinal dural arteriovenous fistulas[J]. Neuro-radiology, 2008, 50(10):869-876. |
| [9] | Narvid J, Hetts SW, Larsen D, et al. Spinal dural arteriovenous fistulae: Clinical features and long-term results[J]. Neurosurge-ry, 2008, 62(1):159-167. |
| [10] | Park SB, Han MH, Jahng TA, et al. Spinal dural arteriovenous fistulas: Clinical experience with endovascular treatment as a primary therapeutic modality[J]. J Korean Neurosurg Soc, 2008, 44(6):364-369. |
| [11] | Sherif C, Gruber A, Bavinzski G, et al. Long-term outcome of a multidisciplinary concept of spinal dural arteriovenous fistulae treatment[J]. Neuroradiology, 2008, 50(1):67-74. |
| [12] | Hessler C, Regelsberger J, Grzyska U, et al. Therapeutic clues in spinal dural arteriovenous fistulas: A 30 year experience of 156 cases[J]. Cent Eur Neurosurg, 2010, 71(1):8-12. |
| [13] | Shinoyama M, Endo T, Takahash T, et al. Long-term outcome of cervical and thoracolumbar dural arteriovenous fistulas with emphasis on sensory disturbance and neuropathic pain[J]. World Neurosurg, 2010, 73(4):401-408. |
| [14] | Kaufmann TJ, Morris JM, Saladino A, et al. Magnetic resonance imaging findings in treated spinal dural arteriovenous fistulas: lack of correlation with clinical outcomes[J]. J Neurosurg Spine, 2011, 14(4):548-554. |
| [15] | Ruiz-Juretschke F, Perez-Calvo JM, Castro E, et al. A single-center, long-term study of spinal dural arteriovenous fistulas with multidisciplinary treatment[J]. J Clin Neurosci, 2011, 18(12):1662-1666. |
| [16] | Cenzato M, Debernardi A, Stefini R, et al. Spinal dural arteriovenous fistulas: Outcome and prognostic factors[J]. Neurosurg Focus, 2012, 32(5):E11. |
| [17] | Cho WS, Kim KJ, Kwon OK, et al. Clinical features and treatment outcomes of the spinal arteriovenous fistulas and malformation: Clinical article[J]. J Neurosurg Spine, 2013, 19(2):207-216. |
| [18] | Clark S, Powell G, Kandasamy J, et al. Spinal dural arteriovenous fistulas: Presentation, management and outcome in a single neurosurgical institution[J]. Br J Neurosurg, 2013, 27(4):465-470. |
| [19] | Gemmete JJ, Chaudhary N, Elias AE, et al. Spinal dural arteriovenous fistulas: Clinical experience with endovascular treatment as a primary therapy at 2 academic referral centers[J]. AJNR Am J Neuroradiol, 2013, 34(10):1974-1979. |
| [20] | Inagawa S, Yamashita S, Hiramatsu H, et al. Clinical results after the multidisciplinary treatment of spinal arteriovenous fistulas[J]. Jpn J Radiol, 2013, 31(7):455-464. |
| [21] | Kirsch M, Berg-Dammer E, Musahl C, et al. Endovascular management of spinal dural arteriovenous fistulas in 78 patients[J]. Neuroradiology, 2013, 55(3):337-343. |
| [22] | Takai K, Kin T, Oyama H, et al. Three-dimensional angioarchitecture of spinal dural arteriovenous fistulas, with special reference to the intradural retrograde venous drainage system[J]. J Neurosurg Spine, 2013, 18(4):398-408. |
| [23] | Gokhale S, Khan SA, McDonagh DL, et al. Comparison of surgical and endovascular approach in management of spinal dural arteriovenous fistulas: A single center experience of 27 patients[J]. Surg Neurol Int, 2014, 5:7. |
| [24] | Qi X, Lv L, Han K, et al. Analysis of the embolization spinal dural arteriovenous fistula and surgical treatments on 52 cases of the patients[J]. Int J Clin Exp Med, 2014, 7(9):3062-3071. |
| [25] | Rashad S, Abdel-Bary M, Aziz W, et al. Management of spinal dural arterio-venous fistulas: Report of 12 cases and review of lite-rature[J]. Clin Neurol Neurosurg, 2014, 125:81-86. |
| [26] | Yen PP, Ritchie KC, Shankar JJ. Spinal dural arteriovenous fistula: Correlation between radiological and clinical findings[J]. J Neurosurg Spine, 2014, 21(5):837-842. |
| [27] | Chibbaro S, Gory B, Marsella M, et al. Surgical management of spinal dural arteriovenous fistulas[J]. J Clin Neurosci, 2015, 22(1):180-183. |
| [28] | Özkan N, Kreitschmann-Andermahr I, Goerike SL, et al. Single center experience with treatment of spinal dural arteriovenous fistulas[J]. Neurosurg Rev, 2015, 38(4):683-692. |
| [29] | Shin DA, Park KY, Ji GY, et al. The use of magnetic resonance imaging in predicting the clinical outcome of spinal arteriovenous fistula[J]. Yonsei Med J, 2015, 56(2):397-402. |
| [30] | Sri D, Higgins N, Laing R. Combined radiological and surgical management of spinal dural fistulas[J]. Br J Neurosurg, 2015, 29(4):505-507. |
| [31] | Zogopoulos P, Nakamura H, Ozaki T, et al. Endovascular and surgical treatment of spinal dural arteriovenous fistulas: Assessment of post-treatment clinical outcome[J]. Neurol Med Chir (Tokyo), 2016, 56(1):27-32. |
| [32] | Lee J, Lim YM, Suh DC, et al. Clinical presentation, imaging findings, and prognosis of spinal dural arteriovenous fistula[J]. J Clin Neurosci, 2016, 26:105-109. |
| [33] | Sasamori T, Hida K, Yano S, et al. Long-term outcomes after surgical and endovascular treatment of spinal dural arteriovenous fistulae[J]. Eur Spine J, 2016, 25(3):748-754. |
| [34] | Adrianto Y, Yang KH, Koo HW, et al. Concomitant origin of the anterior or posterior spinal artery with the feeder of a spinal dural arteriovenous fistula (SDAVF)[J]. J Neurointerv Surg, 2017, 9(4):405-410. |
| [35] | Durnford AJ, Hempenstall J, Sadek AR, et al. Degree and duration of functional improvement on long-term follow-up of spinal dural arteriovenous fistulae occluded by endovascular and surgical treatment[J]. World Neurosurg, 2017, 107:488-494. |
| [36] | Gross BA, Albuquerque FC, Moon K, et al. Validation of an “endovascular-first” approach to spinal dural arteriovenous fistulas: An intention-to-treat analysis[J]. J Neurointerv Surg, 2017, 9(1):102-105. |
| [37] | Koch MJ, Stapleton CJ, Agarwalla PK, et al. Open and endovascular treatment of spinal dural arteriovenous fistulas: A 10-year experience[J]. J Neurosurg Spine, 2017, 26(4):519-523. |
| [38] | Ma Y, Chen S, Peng C, et al. Clinical outcomes and prognostic factors in patients with spinal dural arteriovenous fistulas: A prospective cohort study in two Chinese centres[J]. BMJ Open, 2018, 8(1):e019800. |
| [39] | Bretonnier M, Hénaux PL, Gaberel T, et al. Spinal dural arteriovenous fistulas: Clinical outcome after surgery versus embolization: A retrospective study[J]. World Neurosurg, 2019, 127:e943-e949. |
| [40] | 黄承光, 白如林, 陈左权, 等. 15例脊髓硬脊膜动静脉瘘栓塞和手术治疗[J]. 中华神经外科杂志, 2003, 19(5):340. |
| [41] | 李萌, 张鸿祺, 支兴龙, 等. 硬脊膜动静脉瘘的诊断和治疗[J]. 中华外科杂志, 2003, 41(2):99-102. |
| [42] | 潘力, 马廉亭, 余泽, 等. 硬脊膜动静脉瘘的诊治探讨[J]. 中华外科杂志, 2005, 43(5):330-340. |
| [43] | 于加省, 陈劲草, 雷霆, 等. 骶部硬脊膜动静脉瘘的诊断与治疗[J]. 华中科技大学学报(医学版), 2008, 37(3):409-411. |
| [44] | 于加省, 何跃, 陈如东, 等. 硬脊膜动静脉瘘的显微手术与血管内栓塞治疗[J]. 中华神经外科杂志, 2012, 28(7):706-709. |
| [45] | 李治国, 潘力术, 杨铭, 等. 硬脊膜动静脉瘘的治疗策略的选择. 中华中青年神经外科交流协会第二届学术大会论文集[C]. 苏州: 中华中青年神经外科交流协会, 2013: 314-318. |
| [46] | 齐向前, 韩凯伟, 许政, 等. 硬脊膜动静脉瘘的栓塞和手术治疗[J]. 中国微侵袭神经外科杂志, 2014, 19(8):345-348. |
| [47] | 赵丹. 血管内栓塞治疗颅颈交界区硬脊膜动静脉瘘50例临床分析[J]. 大家健康(学术版), 2014, 8(15):291. |
| [48] | 蔡明俊, 马廉亭, 杨铭, 等. 硬脊膜动静脉瘘的治疗分析[J]. 中国临床神经外科杂志, 2018, 23(6):392-394. |
| [49] | 张仁德, 王蒙, 王俊宽, 等. 硬脊膜动静脉瘘的治疗及预后相关因素分析[J]. 郑州大学学报(医学版), 2018, 53(4):529-534. |
| [50] | 胡智洪. 41例脊髓硬脊膜动静脉瘘患者手术方式、预后回顾性分析研究[D]. 四川泸州: 西南医科大学, 2019. |
| [51] | Thron A. Spinale durale arteriovenöse Fisteln [Spinal dural arteriovenous fistulas][J]. Radiologe, 2001, 41(11):955-960. |
| [52] | Guillevin R, Vallee JN, Cormier E, et al. N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae: CT evaluation, technical features, and outcome prognosis in 26 cases[J]. AJNR Am J Neuroradiol, 2005, 26(4):929-935. |
| [53] | Nogueira RG, Dabus G, Rabinov JD, et al. Onyx embolization for the treatment of spinal dural arteriovenous fistulae: Initial expe-rience with long-term follow-up. Technical case report[J]. Neurosurgery, 2009, 64(1):E197-E198. |
| [54] | Steinmetz MP, Chow MM, Krishnaney AA, et al. Outcome after the treatment of spinal dural arteriovenous fistulae: A contemporary single-institution series and meta-analysis[J]. Neurosurgery, 2004, 55(1):77-88. |
| [55] | Bakker NA, Uyttenboogaart M, Luijckx GJ, et al. Recurrence rates after surgical or endovascular treatment of spinal dural arteriovenous fistulas: A meta-analysis[J]. Neurosurgery, 2015, 77(1):137-144. |
| [56] | 丁璇, 王志刚, 沈寻, 等. NBCA和ONYX栓塞治疗不同类型脑动静脉畸形的对比研究[J]. 中华神经外科杂志, 2006, 22(8):464-466. |
| [57] | Blackburn SL, Kadkhodayan Y, Ray WZ, et al. Onyx is asso-ciated with poor venous penetration in the treatment of spinal dural arteriovenous fistulas[J]. J Neurointerv Surg, 2014, 6(7):536-540. |
| [58] | Marquardt G, Berkefeld J, Seifert V, et al. Preoperative coil marking to facilitate intraoperative localization of spinal dural arteriovenous fistulas[J]. Eur Spine J, 2009, 18(8):1117-1120. |
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