Microneurosurgery for Spinal Dural Arteriovenous Fistula- Operative Video

• Published in: Neurology India Vol. 70; no. 1; pp. 54 - 56
• Main Authors: Das, Kuntal, Nangarwal, Bhawan, Gosal, Jaskaran, Bhaisora, Kamlesh, Srinivasan, Rahul, Srivastava, Arun
• Format: Journal Article
• Language: English
• Published: India Wolters Kluwer India Pvt. Ltd 01.01.2022; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd
• Subjects: Angiography; Care and treatment; Case studies; Central nervous system diseases; Central Nervous System Vascular Malformations - diagnostic imaging; Central Nervous System Vascular Malformations - surgery; Fistula; Fistula, Arteriovenous; Humans; Laminectomy; Male; Methods; Microsurgery; Microsurgery - methods; Middle Aged; Nervous system; Neurosurgical Procedures - methods; Spinal Cord - blood supply; Spinal Cord - surgery; Spine - surgery; Surgery; India; surgery for SDAVF is an example of the critical role of surgery in cerebrovascular diseases; surgical occlusionKey Messages: In this era of endovascular technical advances; spinal DAVF; and this art must be learned by all neurosurgeons; Dural AV fistula; microsurgery; surgical occlusion
• ISSN: 0028-3886; 1998-4022
• DOI: 10.4103/0028-3886.338640

Background and Introduction: Spinal dural arteriovenous fistula (SDAVF) is a rare but curable condition. Microsurgery is a highly effective and readily affordable treatment modality. Objective: We present a surgical video of SDAVF to demonstrate the operative nuances involved. Surgical Technique: A 53-year-old wheelchair-bound man with spastic paraparesis for 1.5 years was found to have a SDAVF at L1/2 level with a single fistula point. During surgery, a L1-L2 laminectomy and durotomy revealed a dilated vein accompanying the nerve root exiting L1/2 foramen that showed early filling on indocyanine green (ICG) video angiography. This vein was occluded, and a segment of this vein was removed during surgery, which led to resumption of normal spinal cord perfusion. Results: The patient showed gradual recovery of lower limb motor power and improved to assisted ambulation after 3 months. Conclusions: Surgery is a simple, effective, and cost-effective treatment option in SDAVF.