To determine presenting features, treatment modalities and associated outcome following treatment of spinal dural arteriovenous fistulas in a tertiary centre.

Retrospective cohort study of patients with SDAVF assessed at a single tertiary referral centre, between 1999 and 2009. Medical records were used to identify intervention type, pre- and post-intervention Aminoff-Logue disability score (ALDS), recurrence rate, follow-up time and discharge status. Statistical analysis was performed using Wilcoxon signed rank.

26 patients were identified with 23 receiving intervention. Two were unavailable for follow up. Endovascular embolization was performed successfully in 13 patients, recurrence occurred in 6 of these, 3 of which were subsequently treated surgically. Surgery was the initial treatment for 10 patients due to either unsuccessful embolization attempt or proximity of the fistula to spinal artery feeders; only 1 of these recurred. ALDS-gait reduced (improved) by a mean of 0.33 points following intervention but this was not statistically significant (P=0.0645). There was negligible change in micturition and bowel ALDS. Improvement in ALDS was greater in patients treated with surgery first and also in patients whose fistula did not recur. Mean follow-up was 38 months with 56% of working age patients returning to work.

Both embolisation and surgery achieved the primary aim of reducing disease progression, leading to an improved ALDS. Outcome was superior if initially treated surgically and recurrence occurred more frequently in patients treated endovascularly. The small number of patients in our cohort emphasise the need for further studies into this group of patients.

Purpose: To compare the postoperative cerebrospinal fluid (CSF) leak rate in two consecutive cohorts of patients undergoing intradural spinal tumour excision with 2 different dural closure techniques.

Methods and Result: Data for this study was collected retrospectively from case notes. Between January 1994 and December 2001 forty seven intradural (thirty two extramedullary and fifteen intramedullary) spinal tumour excisions were performed. The dural incision was closed using vicryl 6.0. Operations of nine patients in this group (19 %) were complicated by CSF leak. From 2002 onwards the closure method for dural incisions was changed to single layer continuous prolene 6.0 suture in conjunction with a check valsalva manoeuvre prior to closure of wound incision in an attempt to reduce the incidence of CSF leak. Fifty three (thirty three extramedullary and twenty intramedullary) patients underwent intradural spinal tumour excision between January 2002 and October 2008. Three (5.7%) patients developed cerebrospinal fluid leak and one (1.9%) patient developed a pseudomeningocele post operatively. All four patients were subsequently managed with a lumbar drain. In both groups of patients good exposure of the proximal and distal aspect was achieved prior to dural closure. Statistical analysis comparing the outcome of both groups was performed using Fisher’s exact test – p values calculated were 0.0381 (one-tailed) and 0.0618 (two-tailed).

Conclusion: Single layer continuous prolene suture in conjunction with a check valsalva manoeuvre is superior to vicryl alone for the closure of the dura post intradural spinal tumour excision. The reduction in the leak rate may be due to the valsalva manoeuvre itself rather than the different suture material. Along with good exposure to the proximal and distal aspect of the incision we feel that this can reduce post operative cerebrospinal fluid leak in intradural spinal tumour excision operations.