P.050 Minimally invasive disconnection of spinal dural arteriovenous fistulas in a hybrid neurovascular operating room

Abstract

Background: Hybrid neurovascular operating rooms offer significant advantages for vascular neurosurgery. In 2008, we installed North America’s first robotic intraoperative rotational 2D/3D angiography unit in a neurosurgery operating room. To date, 200 procedures have been performed. Methods: In selected cases of spinal dural arteriovenous fistula (dAVF)requiring surgical disconnection, intraoperative spinal angiographic roadmapping, angiographic image overlay onto the skin and surgically exposed spine, and laser cross-hair image guidance were utilized to accurately determine the location and trajectory of the draining vein. Results: In four cases of spinal dAVF, a minimally invasive approach was employed, via either single-level (N=2) or two-level (N=1) hemilaminectomy. Techniques used included: angiographic roadmap / image overlay and intraoperative fluoroscopic with laser light guidance. These provided sub-centimeter accuracy in localizing the path of the draining vein. Surgical incision lengths ranged between 4 to 5 cm, with the shortest incision measuring only 4.2 cm. Complete cure was obtained in all cases, with no untoward complications. Conclusions: Hybrid neurovascular operating room technology can facilitate the use of minimally invasive approaches to spinal dural AVF disconnection.