1128. Intraoperative spinal angiography during microsurgical occlusion of spinal dural arteriovenous fistula

Authors: Javier Fandino, MD, IFAANS; Jenny Kienzler, MD; Marbacher Serge, MD, PhD; Salome Schoepf, MD; Michael Diepers, MD; Luca Remonda, MD; Javier Fandino, MD (Aarau, Switzerland)

Introduction: 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 surgical treated cases, failure of obliteration is reported in up to five percent. The aim of this technical note is to present a safe procedure with complete SDAVF occlusion, verified by an intraoperative spinal angiography. Methods: We report on four cases with progressive leg weakness that underwent surgical obliteration of their SDAVF with intraoperative spinal angiography. The spinal dural AV-Fistula of the first patient had the main feeder arising from the right T11 segmental artery, which supplied the artery as well of Adamkiewicz. The SDAVF of the second patient was initially treated endovascular, but after 5 months he clinically deteriorated due to recanalization of the SDAVF by a small branch of the T12 segmental artery. The third case was primarily planned for surgical occlusion. Results: The procedures were done in prone position and the popliteal artery gained the access for the spinal angiography. An angiography was performed pre- and intraoperative after clipping of the fistula point and occlusion of the SDAVF. Access through popliteal artery for spinal angiography showed to be beneficial and safe, allowing the sheath to be left in place during procedure. Therefore, the intraoperative angiography could be available within 15 minutes. The intraoperative angiography showed in one case a misplacement of the clip with failure of fistula occlusion and the clip was directly repositioned. All final intraoperative angiographies showed a complete occlusion of the fistula. Conclusion: Intraoperative spinal angiography is a feasible and safe tool for rapid localization and confirmation of successful occlusion of SDAVF.