Intraoperative Spinal Angiography during Microsurgical Occlusion of Spinal Dural Arteriovenous Fistula within the Hybrid Operation Room

2021 ◽  
Author(s):  
Jenny Christine Kienzler ◽  
Salome Schoepf ◽  
Serge Marbacher ◽  
Michael Diepers ◽  
Luca Remonda ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Prone Position ◽  
Popliteal Artery ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Safe Procedure ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Small Branch

Abstract Background Spinal dural arteriovenous fistula (SDAVF) is a rare cause of progressive myelopathy in predominantly middle-aged men. Treatment modalities include surgical obliteration and endovascular embolization. In surgically treated cases, failure of obliteration is reported in up to 5%. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by intraoperative digital subtraction angiography (DSA). Methods We describe four patients with progressive leg weakness who underwent surgical obliteration of SDAVF with spinal intraoperative DSA in the prone position after cannulation of the popliteal artery. All surgeries took place in our hybrid operating room (OR) and were accompanied by electrophysiologic monitoring. Surgeries and cannulation of the popliteal artery were performed in the prone position. Ultrasound was used to guide the popliteal artery puncture. A 5-Fr sheath was inserted and the fistula was displayed using a 5-Fr spinal catheter. Spinal intraoperative DSA was performed prior to and after temporary clipping of the fistula point as well after the final SDAVF occlusion. Results The main feeder of the SDAVF fistula in the first patient arose from the right T11 segmental artery, which also supplied the artery of Adamkiewicz. The second patient initially underwent endovascular treatment and deteriorated 5 months later due to recanalization of the SDAVF via a small branch of the T12 segmental artery. The third and fourth cases were primarily scheduled for surgical occlusion. Access through the popliteal artery for spinal intraoperative DSA proved to be beneficial and safe in the hybrid OR setting, allowing the sheath to be left in place during the procedure. During exposure and after temporary and permanent occlusion of the fistulous point, intraoperative indocyanine green (ICG) video angiography was also performed. In one case, the addition of intraoperative DSA showed failure of fistula occlusion, which was not visible with ICG angiography, leading to repositioning of the clip. Complete fistula occlusion was documented in all cases. Conclusion Spinal intraoperative DSA in the prone position is a feasible and safe intervention for rapid localization and confirmation of surgical SDAVF occlusion.

scholarly journals Balloon-assisted transarterial embolization of type 1 spinal dural arteriovenous fistula

2014 ◽  
Vol 37 (v1supplement) ◽  
pp. 1
Author(s):  
Brian Lee ◽  
Vivek A. Mehta ◽  
William J. Mack ◽  
Matthew S. Tenser ◽  
Arun P. Amar
Keyword(s):  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Vascular Malformations ◽  
Transarterial Embolization ◽  
Mri Imaging ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Segmental Artery ◽  
Spinal Vascular Malformations

Type 1 spinal dural arteriovenous fistula (dAVF) constitute the vast majority of all spinal vascular malformations. Here we present the case of a 71-year-old male with progressive myelopathy, lower-extremity weakness and numbness, and urinary incontinence. MRI imaging of the thoracic spine demonstrated cord edema, and catheter spinal angiography confirmed a type 1 spinal dAVF. The fistula was supplied by small dural branches of the left L-2 segmental artery. Angiographic cure was achieved with a one-stage procedure in which coils were used to occlude the distal segmental vessels, followed by balloon-assisted embolization with Onyx.The video can be found here: http://youtu.be/8aehJbueH0U.

scholarly journals Spinal dural arteriovenous fistula presenting as low back pain

2018 ◽  
Vol 26 (4) ◽  
pp. 250-253
Author(s):  
Kwok-Chun Chan ◽  
Fu-Jen Cheng ◽  
Chih-Wei Hsu ◽  
I-Ting Tsai ◽  
Choon-Bing Chua ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Low Back Pain ◽  
Back Pain ◽  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Low Back ◽  
Resonance Imaging ◽  
Spinal Dural Arteriovenous Fistula

Introduction: Low back pain or numbness of the lower extremities is quite common in the present population. Numerous conditions may cause these symptoms, including spinal vascular anomaly. Identifying and diagnosing the cause of these symptoms are crucial for treatment. Accurate diagnosis based on particular radiological findings in magnetic resonance imaging is crucial for administering adequate therapy to patients, especially in spinal dural arteriovenous fistula. Case presentation: We report a case presenting with low back pain and rapid deterioration in paraplegia. Magnetic resonance imaging provided the typical image presentations such as spinal cord edema with tortuous dilated perimedullary venous plexus. The patient was subsequently successfully treated with endovascular embolization. Discussion: Spinal dural arteriovenous fistula should be suspected in any patient who presents with myelopathy. Angiography remains the gold standard for confirmation of diagnosis. Conclusion: Prompt treatment with endovascular embolization or surgery could improve patients’ outcomes.

Usefulness of three-dimensional digital subtraction angiography in endovascular treatment of a spinal dural arteriovenous fistula

2008 ◽  
Vol 8 (5) ◽  
pp. 462-467 ◽  
Author(s):  
Noriaki Matsubara ◽  
Shigeru Miyachi ◽  
Takashi Izumi ◽  
Tomotaka Ohshima ◽  
Arihito Tsurumi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Bone Structure ◽  
Maximum Intensity Projection ◽  
Endovascular Embolization ◽  
Intercostal Artery ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Relationship

✓The use of 3D digital subtraction (DS) angiography provides a better understanding of spinal vascular lesion architecture. The authors report on 2 cases involving a spinal dural arteriovenous fistula (DAVF) and demonstrate the usefulness of 3D DS angiography for endovascular treatment of these spinal DAVFs. In both cases, middle-aged male patients suffered from bilateral leg hypesthesia, gait disturbance, and urinary dysfunction several months before treatment. Spinal angiography revealed DAVFs that were fed by a radicular artery branching from the intercostal artery and draining veins proceeding superiorly along the perimedullary veins. Endovascular embolization was performed in both cases. Selective 3D DS angiography of the intercostal artery clearly demonstrated the tortuous course of the feeder and the relationship among the feeding artery, fistula point, and draining veins in each case. This information was very useful in selecting a working angle for manipulating the microcatheter and for glue injection. In addition, the maximum intensity projection image from rotational DS angiography data clearly showed the fistula point at the dural sleeve and feeder entering the spinal canal via the intervertebral foramen and the relationship with the bone structure. Successful obliteration of the fistulae was achieved in both cases. Selective spinal 3D DS angiography was very useful in understanding the complex spinal vascular architecture and in choosing the best working angle and therapeutic strategy for endovascular treatment of spinal DAVFs.

scholarly journals Concomitant spinal dural arteriovenous fistula and nodular fasciitis in an adolescent: case report

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Chan-Lin Chu ◽  
Yu-Jen Lu ◽  
Tsong-Hai Lee ◽  
Shih-Ming Jung ◽  
Yu-Cheng Chu ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Subcutaneous Tissue ◽  
Lower Limbs ◽  
Nodular Fasciitis ◽  
Spinal Dural Arteriovenous Fistula ◽  
Case Presentation ◽  
Segmental Artery ◽  
Progressive Weakness

Abstract Background Spinal dural arteriovenous fistula (SDAVF) usually occurs during the 4th to 6th decades of life, and adolescent SDAVF is rarely reported. SDAVF arising around a tumor is also rare, and reported tumors are mostly schwannoma and lipoma. Case presentation We reported a 16-year-old male presented with progressive weakness and numbness of lower limbs for 3 months. A SDAVF was found, which was fed by right radicular arteries from segmental artery at L2 level and drained retrogradely into perimedullary veins. A concomitant spinal extradural nodular fasciitis at right L1/L2 intervertebral foramen was also noted. The SDAVF was completely obliterated by endovascular treatment and the tumor was debulked. The patient recovered well after the procedures. Conclusions Our case report suggests SDAVF can occur in adolescent. The concomitant presence with a nodular fasciitis indicates that although it usually arises in subcutaneous tissue but can rarely form on the dura of spine.

Spinal dural arteriovenous fistula presenting with paraplegia following lumbar puncture

2013 ◽  
Vol 19 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Guus Koerts ◽  
Vincent Vanthuyne ◽  
Maxime Delavallee ◽  
Herbert Rooijakkers ◽  
Christian Raftopoulos
Keyword(s):  
Arteriovenous Fistula ◽  
Lumbar Puncture ◽  
Dural Arteriovenous Fistula ◽  
Treatment Options ◽  
Venous Hypertension ◽  
Spinal Dural Arteriovenous Fistula ◽  
Segmental Artery ◽  
Arteriovenous Fistulas ◽  
Underlying Mechanisms ◽  
Spinal Dural Arteriovenous Fistulas

Spinal dural arteriovenous fistulas are rare lesions with an annual incidence of 1 per 100,000 population. In patients with this disease, an abnormal vascular dural shunt exists between a dural branch of a segmental artery and a subdural radicular vein that drains the perimedullary venous system, leading to venous hypertension and secondary congestive myelopathy. Generally, patients present with progressive paraparesis, urinary disturbances, and gait ataxia. In this report the authors describe a 61-year-old woman with a spinal dural arteriovenous fistula who developed an acute paraplegia after a nontraumatic lumbar puncture. The possible underlying mechanisms and treatment options are discussed.

Spinal Dural Arteriovenous Fistula: Diagnosis and Treatment

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Nur Setiawan Suroto
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Dural Arteriovenous Fistula ◽  
Motor Symptoms ◽  
Elderly Men ◽  
Spinal Dural Arteriovenous Fistula ◽  
Sensory Disturbances ◽  
Av Fistulas ◽  
Low Rate

Spinal dural arteriovenous (AV) fistulas are the most commonly encountered vascular malformation of the spinal cord and a treatable cause for progressive paraplegia or tetraplegia. They most commonly affected are elderly men and are classically found in the thoracolumbar region.Symptoms gradually progress or decline in a stepwise manner and are commonly associated with pain and sphincter disturbances. Surgical or endovascular disconnection of the fistula has a high success rate with a low rate of morbidity. Motor symptoms are most likely to improve after treatment, followed by sensory disturbances, and lastly sphincter disturbances.

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