Surgical Management of Failed Endovascular Treatment for Spinal Dural Arteriovenous Fistulas.
Dural arteriovenous fistula
ICG
Spinal DAVF
Spinal angiography
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
07
10
2020
revised:
09
12
2020
accepted:
10
12
2020
pubmed:
22
12
2020
medline:
10
7
2021
entrez:
21
12
2020
Statut:
ppublish
Résumé
Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations. Digital subtraction angiography is the modality of choice to demonstrate the malformation before endovascular embolization or open surgical repair. Angiographically occult SDAVFs have been previously reported. Surgical considerations in SDAVFs with misleading angiography findings have not yet been assessed. A retrospective evaluation of charts and imaging files of patients operated on for SDAVF in 2018-2019 at a single institution was performed. All patients were referred to surgery following failure of endovascular embolization or owing to clinical and radiographic deterioration in the presence of an angiographically occult lesion. Cases were comprehensively reviewed and evaluated for surgical considerations in these lesions. This case series included 4 cases. Two patients underwent embolization before surgical repair but continued to deteriorate neurologically, and 2 patients had a failed embolization attempt owing to a torturous vascular network. In all 4 patients, exploration was successful, yielding either improvement or stabilization of neurological status. Indocyanine green injection for microscopically integrated fluorescent angiography contributed to the identification of the supplying vessels and confirmed the SDAVF closure. SDAVFs should be treated promptly after diagnosis. In cases with high suspicion for SDAVF with occult or misleading angiography findings, spinal exploration should be pursued with no delay. Indocyanine green-assisted microscopic angiography may contribute to exploratory spine surgery for SDAVF closure.
Sections du résumé
BACKGROUND
Spinal dural arteriovenous fistulas (SDAVFs) are rare vascular malformations. Digital subtraction angiography is the modality of choice to demonstrate the malformation before endovascular embolization or open surgical repair. Angiographically occult SDAVFs have been previously reported. Surgical considerations in SDAVFs with misleading angiography findings have not yet been assessed.
METHODS
A retrospective evaluation of charts and imaging files of patients operated on for SDAVF in 2018-2019 at a single institution was performed. All patients were referred to surgery following failure of endovascular embolization or owing to clinical and radiographic deterioration in the presence of an angiographically occult lesion. Cases were comprehensively reviewed and evaluated for surgical considerations in these lesions.
RESULTS
This case series included 4 cases. Two patients underwent embolization before surgical repair but continued to deteriorate neurologically, and 2 patients had a failed embolization attempt owing to a torturous vascular network. In all 4 patients, exploration was successful, yielding either improvement or stabilization of neurological status. Indocyanine green injection for microscopically integrated fluorescent angiography contributed to the identification of the supplying vessels and confirmed the SDAVF closure.
CONCLUSIONS
SDAVFs should be treated promptly after diagnosis. In cases with high suspicion for SDAVF with occult or misleading angiography findings, spinal exploration should be pursued with no delay. Indocyanine green-assisted microscopic angiography may contribute to exploratory spine surgery for SDAVF closure.
Identifiants
pubmed: 33346051
pii: S1878-8750(20)32628-0
doi: 10.1016/j.wneu.2020.12.062
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e354-e362Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.