Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arterovenous Fistula: A Useful Application

Surgical evolution in spinal dural arteriovenous fistula treatment-a 7 years monocentric experience

Accounting for 70% of all spinal vascular malformations, spinal dural arteriovenous fistulas (SDAVF) are the most common type of malformation. Interruption of the fistulous arterialized vein point is the goal of surgical treatment. The aim of the study was to compare open surgery (laminectomy) versus minimal invasive surgery (MIS) in SDAVF treatment. Between March 2013 and March 2020, we retrospectively collected 21 consecutive adult patients with SDAVF. Since March 2017, MIS has been routinely used for surgical treatment. Pre- and post-operative clinical evaluations used Aminoff-Logue score (ALS). Complication rate was noted. Post-operative occlusion of the malformation was confirmed by digital subtraction angiography (DSA) in all patients. MIS was compared to open surgery in terms of efficacy and complications with statistical evaluation. Standard laminectomy was performed in 12 patients and MIS technique in 9 patients. No difference was noted on pre-operative parameters. ALS and MRI signs of myelopathy were improved in all cases except for 1 patient in each group. All SDAVFs were excluded based on post-operative DSA. Significant differences were noted between the 2 groups in terms of perioperative blood loss (p<0.001), post-operative pain visual analog scale values (p<0.001), and first time out of bed (p<0.001). Wrong level surgery occurred in one patient in each group; patients were re-operated using the same technique. No infection or cerebrospinal fluid (CSF) leak was noted. In our experience, MIS is a safe alternative to open laminectomy for SDAVF treatment. MIS contributes to patient comfort and minimizes blood loss without increasing complication rate.

Multimodal Intraoperative Monitoring During Microsurgical Treatment of Spinal Dural Arteriovenous Fistula

We report here a case to illustrate the potential intraoperative multimodal monitoring options available for safe ligation of spinal dural arteriovenous fistula (DAVF). The success of microsurgical treatment depends on the correct identification of the arterial feeder and monitoring the functional integrity of the corticospinal tract.

Patient Outcomes Following Obliteration of Spinal Dural Arteriovenous Fistula and the Role of Indocyanine Green Angiography Videoangiography (ICG‑VA) During Surgery

Background

Spinal dural arteriovenous fistula (SDAVF) is a known cause of progressive myelopathy which can be treated either by surgery or embolization. Indocyanine green angiography videoangiography (ICG-VA) during surgery can locate the exact location of AV shunting.

Objective

To determine the clinical outcome following obliteration of the fistula and to study the role of ICG in identifying the presence and location of SDAVF; to add a comparative study of patients treated by embolization.

Materials and Methods

Patients treated for SDAVF in our centre from 2005 to 2015 were studied for clinical and radiological features, and outcome following obliteration of fistula.

Results

Of the total 33 patients (27 males, six females), 19 patients were operated without the use of ICG, nine were operated with the use of ICG and successful embolization was done in five. Acute presentation was seen in five. Single feeder was seen in 20 patients, multiple in 13. Mean follow-up was 58 months. All patients in ICG group improved. Three out of 19 patients in the non-ICG group (15.78%) required re-operation. With the use of ICG, the improvement in Aminoff Logue score was significantly better (P < 0.005). Embolization was tried in 13 cases, but successful in five (38%).

Conclusions

Surgery with intraoperative ICG shows the exact location of AVF. This decreases the chance of postoperative clinical deterioration and improves patient outcome.