Surgical ligation of spinal dural arteriovenous fistula
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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.
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.
Laminectomy and arteriovenous fistula ligation is a safe and reliable approach for accessing and treating spinal dural arteriovenous fistulas.
KeywordsArteriovenous spinal fistula Spinal dural fistula treatment Spinal arteriovenous shunt
Compliance with ethical standards
Conflict of interest
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.
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)
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