The Failure of Operation for Spinal Dural Arteriovenous Fistula demonstrated by Intraoperative Indocyanine Green Video-Angiography

Seong Yi

doi:10.7759/cureus.205

Abstract

Our objective was to both describe and show (via video) the use of intraoperative indocyanine green (ICG) video-angiography for obliteration of a spinal dural arteriovenous fistula (DAVF). ICG video-angiography is an emerging tool for delineating intraoperative vascular anatomy with significant potential in the treatment of vascular diseases in the spine. The authors presented the case of a 49-year-old woman with progressive and debilitating bilateral lower-extremity weakness. The patient was diagnosed with a spinal AVM of the 10th thoracic vertebra based on the results of conventional spinal angiography. The patient underwent T8-9 laminotomy for microsurgical clip occlusion. Intraoperative ICG video-angiography was used before clip placement to identify the arterialized veins of the fistula, as well as after clip placement to confirm obliteration of the fistulous connection. The authors failed to restore the normal blood flow through repeated temporary clip and ICG angiography. In conclusion, intraoperative ICG video-angiography serves an important role in the microsurgical treatment of DAVF. It is simple process that provides real-time information regarding both the precise location of spinal DAVF and the result of spinal DAVF obliteration. The lack of understanding of anomalous vascular anatomy could be the cause of failure.

Highlights

Spinal vascular malformations represent around 2-4% of all spinal diseases, and spinal dural arteriovenous fistulae (DAVFs) are the most common among them [1,2,3]
Neurological impairment from spinal DAVFs is attributed to arterialization of intramedullary veins with subsequent venous hypertension; it can be attributed to infarction in some cases [6,7]
We present a case of failure when using indocyanine green (ICG) video-angiography in the microsurgical treatment of symptomatic spinal DAVFs

Summary

Introduction

Spinal vascular malformations represent around 2-4% of all spinal diseases, and spinal dural arteriovenous fistulae (DAVFs) are the most common among them [1,2,3]. These lesions are vascular abnormalities in which a pathological arteriovenous shunt is located in the dural leaflets, typically at the intervertebral foramen [4,5]. How to cite this article Yi S (September 17, 2014) The Failure of Operation for Spinal Dural Arteriovenous Fistula Demonstrated by Intraoperative Indocyanine Green Video-Angiography.

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Discussion

Conclusion