N-butyl 2-cyanoacrylate embolization of spinal dural arteriovenous fistulae

BACKGROUND AND PURPOSE: Because they are not well established, we investiga ted the technical success and recurrence rates of n-butyl 2-cyanoacrylate ( NBCA) embolization of spinal dural arteriovenous fistulae (SDAVF), and asse ssed clinical outcomes. METHODS: We retrospectively studied all patients with SDAVF treated by NBCA embolization at our institution over an 8-year period. Gait and micturitio n 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 p atients who underwent embolization, initial embolization failure occurred i n two (10%) and fistula occurrence in three (15%). All five patients in who m NBCA embolization failed underwent surgery. All patients who underwent em bolization had either improved (55%) or unchanged (45%) gait disability at last follow-up. Seventeen (85%) patients had improved (40%) or unchanged (4 5%) micturition disability, but three (15%) had worsened. Mean Aminoff gait disability grade significantly decreased at last follow-up (2.4 [1.4] aver age [SD] vs 3.2 [1.4] [P = .0008]), Mean micturition disability grade decre ased, 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 p atients. 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 ap pears efficacious, significantly improving mean gait disability by almost o ne grade at last follow-up. Close clinical and angiographic surveillance is mandatory. Longer and more uniform follow-up is needed to determine if cli nical improvement and stabilization after NBCA embolization are sustained.