Intra-operative spinal digital subtraction angiography combined with selective intra-arterial injection of methylene blue for angiography: a new method to extirpate spinal dural arteriovenous fistulae

Abstract

Objective To evaluate the clinical values of intra-operative spinal digital subtraction angiography and selective intra-arterial injection of methylene blue for angiography in the surgical treatment of spinal dural ateriovenous fistula (SDAVF). Methods Four patients underwent microsurgical treatment combined with intra-operative spinal DSA for SDAVF in our hospital from January 2015 to December 2015 were chosen. Selective intra-arterial injection of methylene blue was applicated in three of them. The clinical data and treatment efficacy of these patients were retrospectively analyzed. Results Intra-operative spinal DSA and selective intra-arterial methylene blue injection were performed successfully and no complications occurred. The fistulae were all confirmed to be extirpated by intraoperative angiography. All the four patients who complicated with spinal nerve function impairment recovered to different extents in 4-9 months of follow-up. Modified Aminoff-Logue scale scores decreased by 1-3, with an average of 2.25 within the follow up period. Conclusion Intra-operative spinal DSA and selective intra-arterial injection of methylene blue for angiography are safe and effective, making the surgery conducted less invasively, especially in surgery for complex arteriovenous fistulas. Key words: Spinal cord vascular disease; Arteriovenous fistula; Digital subtraction angiography; Methylene blue