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Minimally invasive microsurgical treatment of spinal dural arteriovenous fistula: how I do it

  • How I Do it - Vascular Neurosurgery - Arteriovenous malformation
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Abstract

Background

Spinal dural arteriovenous fistula (d-AVF) is the most common spinal vascular malformations. Management includes endovascular embolization, and/or surgical obliteration of the shunt.

Method

Applied to spinal d-AVF, mini-invasive surgical (MIS) obliteration is described as a mini-open approach using Mast Quadrant™ system. Important anatomical landmarks are reviewed. Indications, advantages, and limitations are discussed, and a step-by-step description of the procedure is presented.

Conclusion

MIS is a good solution to treat d-AVF with a good outcome.

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Abbreviations

CT:

Computed tomography

d-AVF:

Dural arteriovenous fistula

min:

Minute

MIS:

Mini-invasive surgery

MRI:

Magnetic resonance imagery

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Author information

Author notes

  1. Albader Faisal and Nicolas Serratrice contribute equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, La Timone Hospital (Assistance Publique - Hôpitaux de Marseille), Marseille, France

    Faisal Albader, Nicolas Serratrice, Kaissar Farah & Stéphane Fuentes

Authors
  1. Faisal Albader
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  2. Nicolas Serratrice
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  3. Kaissar Farah
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  4. Stéphane Fuentes
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Corresponding author

Correspondence to Nicolas Serratrice.

Ethics declarations

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Not applicable.

Informed consent

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Key points

1. Spinal d-AVF are the most common spinal vascular malformations.

2. Treatment is essential to prevent symptom progression and promote recovery.

3. Spinal arteriography is the gold standard test to diagnose spinal d-AVF.

4. Identifying the level of d-AVF and the great Adamkiewicz artery is paramount.

5. When endovascular occlusion is not possible, surgery is the alternative.

6. MIS technique is safe and efficient.

7. Exclusion of the d-AVF is performed with a clip proximal to the shunt and distal coagulation and cutting.

8. Preoperative implantation of a radiopaque marker can be carried out by radiologists to avoid error level especially in thoracic region.

9. Fluorescein angiography is performed to better visualize the d-AVF.

10. Watertight closure of the dura is essential.

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This article is part of the Topical Collection on Vascular Neurosurgery - Arteriovenous malformation

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Albader, F., Serratrice, N., Farah, K. et al. Minimally invasive microsurgical treatment of spinal dural arteriovenous fistula: how I do it. Acta Neurochir 164, 1669–1673 (2022). https://doi.org/10.1007/s00701-022-05200-2

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  • DOI: https://doi.org/10.1007/s00701-022-05200-2

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