Advertisement

Acta Neurochirurgica

, Volume 160, Issue 1, pp 191–194 | Cite as

Surgical ligation of spinal dural arteriovenous fistula

  • Thomas Sorenson
  • Enrico Giordan
  • Delia Cannizzaro
  • Giuseppe LanzinoEmail author
How I Do it - Spine

Abstract

Background

Spinal dural arteriovenous fistulas (SDAVFs) are abnormal arteriovenous shunts between a radicular artery and the radicular vein, located in the dorsal surface of the dura sleeve, which drains in a retrograde manner into the coronal venous plexus of the spinal cord without an interposed capillary network. This result is a venous hypertension that reduces spinal cord perfusion and leads to ischemia and edema. Spontaneous resolution is extremely rare and, once symptomatic, the typical course is further progression with increased neurological impairment. Therefore, once a fistula is diagnosed, treatment is recommended.

Method

The fistula is placed at the level of intervertebral foramen and surgical ligation is performed through a laminectomy. After dural opening, the area is inspected, and the arterialized vein is identified and ligated.

Conclusions

Laminectomy and arteriovenous fistula ligation is a safe and reliable approach for accessing and treating spinal dural arteriovenous fistulas.

Keywords

Arteriovenous spinal fistula Spinal dural fistula treatment Spinal arteriovenous shunt 

Notes

Compliance with ethical standards

Conflict of interest

None.

Informed consent was obtained for the procedure illustrated. However, no institutional review board approval, or patient consent is required per institutional policy for retrospective, single-cases in which no identifiable patient information is shared.

Supplementary material

ESM Video 1

The authors demonstrate the steps for the successful access, cautery and division of a symptomatic spinal dural arteriovenous fistula in an 82-year-old man using a one-level laminectomy. (MP4 180,883 kb)

References

  1. 1.
    Amanieu C, Hermier M, Peyron N, Chabrol A, Deiana G, Manera L (2014) Spinal dural arteriovenous fistula. Diagn Interv Imaging 95:897–902CrossRefPubMedGoogle Scholar
  2. 2.
    Bortolotti C, Morales-Valero SF, Lanzino G (2014) Spinal dural arteriovenous fistulae. Contemp Neurosurg 36:1–5CrossRefGoogle Scholar
  3. 3.
    Krings T, Geibprasert S (2009) Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 30:639–648CrossRefPubMedGoogle Scholar
  4. 4.
    Marcus J, Schwarz J, Singh IP, Sigounas D, Knopman J, Gobin YP, Patsalides A (2013) Spinal dural arteriovenous fistulas: a review. Curr Atheroscler Rep 15:335CrossRefPubMedGoogle Scholar
  5. 5.
    Saladino A, Atkinson JL, Rabinstein AA, Piepgras DG, Marsh WR, Krauss WE, Kaufmann TJ, Lanzino G (2010) Surgical treatment of spinal dural arteriovenous fistulae: a consecutive series of 154 patients. Neurosurgery 67:1350–1357 discussion 1357-1358CrossRefPubMedGoogle Scholar
  6. 6.
    Steinmetz MP, Chow MM, Krishnaney AA, Andrews-Hinders D, Benzel EC, Masaryk TJ, Mayberg MR, Rasmussen PA (2004) Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis. Neurosurgery 55:77–87 discussion 87-78CrossRefPubMedGoogle Scholar
  7. 7.
    Takai K, Komori T, Taniguchi M (2015) Microvascular anatomy of spinal dural arteriovenous fistulas: arteriovenous connections and their relationships with the dura mater. J Neurosurg Spine 23:526–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Thomas Sorenson
    • 1
  • Enrico Giordan
    • 2
  • Delia Cannizzaro
    • 3
    • 4
  • Giuseppe Lanzino
    • 1
    Email author
  1. 1.Department of Neurologic SurgeryMayo ClinicRochesterUSA
  2. 2.Department of Neurologic SurgeryUniversity of PaduaPaduaItaly
  3. 3.Department of Neurologic SurgeryHumanitas Clinical and Research CenterMozzanoItaly
  4. 4.Department of Neurology, Psychiatry and Neurologic SurgerySapienza UniversityRomeItaly

Personalised recommendations