LAUSR

BACKGROUND Given the growing prevalence of initial endovascular treatment for type 1 spinal dural arteriovenous fistulae, there are an increasing number of patients presenting with progressive symptoms related to recurrent previously embolized spinal dAVF. This study's goal was to identify demographic, clinical, and radiographic variables amongst patients who have failed embolization of type I spinal dural arteriovenous fistula. METHODS A retrospective review of 24 consecutive surgeries for type I spinal dAVF performed by the senior author (ADL) identified 5 patients who underwent open surgery for failed embolization. These 5 cases were reviewed for location of fistula, time from embolization to recurrence, preoperative functional status, fistulous point encountered at surgery, and clinical outcome of the patient at three-months follow up. A representative example case is reviewed in detail. RESULTS The median age at time of recurrence was 63 years (range 51-73). The median timing of embolization to recurrence of neurologic symptoms was 5 months (range 1-54), and to surgery- 7 months (range 2-60). The level of the spinal dAVF was most frequently at T12-L1 (n=3). Spinal MRA led to localization of the spinal dAVF in 2 patients and spinal catheter angiogram in 3 cases. All patients had definitive radiographic cure of the dAVF at last clinical follow up. CONCLUSION The increased utilization of endovascular treatment of spinal dAVF has led to treatment of refractory cases with a higher degree of surgical complexity. Open surgical ligation continues to provide the most definitive treatment outcomes for this complex spinal vascular entity.