SURGICAL VIDEO Microsurgical Resection of a Type 1 Spinal Dural Arteriovenous Fistula: A 3-Dimensional Operative Video ∗‡§ ∗‡§ Rami James N. Aoun, MD, MPH , Mithun G. Sattur, MBBS , ∗ ∗‡§¶ ChandanKrishna,MD , Bernard Bendok, MD, MSCI ∗ ‡ Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona; Precision Neuro- therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona; Department of Oto- laryngology, Mayo Clinic, Phoenix Arizona Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ opx115 We present a case of a 54-yr-old male patient who presented with lower extremity weakness and numbness of 1-yr duration. Acknowledgments The patient also complained of perianal and genital numbness The authors would like to thank Aman Gupta, MBBS and Mathew E. Welz, as well as difficulty starting a urinary stream and erectile MA. dysfunction. Physical exam revealed 4/5 bilateral lower extremity motor function with 2/5 left toe dorsiflexion. MRI raised the suspicion of a spinal dural arteriovenous fistula (DAVF). COMMENT Magnetic Resonance Angiography (MRA) revealed a right T9 he authors provide a brief but well-edited look at the relatively spinal DAVF with a large network of abnormal veins on the straightforward process of surgical treatment of type 1 spinal arteri- dorsal spinal cord. Digital subtraction angiography confirmed ovenous fistulae. In the endovascular era, it is important to under- a T9 spinal type 1 DAVF. During angiography, access to the stand the simplicity of this procedure when the appropriate techniques meningeal feeder by a catheter was impeded by its tortuosity. A are applied. The use of indocyanine green (ICG) angiography in these recommendation was then made to proceed with microsurgical cases is debatable. The author, himself, states that he still uses postoper- treatment. In this 3-D surgical video (TrueVision 3D Surgical, ative angiography and leaves a clip for that reason. My own experience Santa Barbara, California), reproduced after informed consent is that angiography is most definitive but will soon be supplanted by was obtained, we illustrate the surgical treatment of this patient’s the regimented use of ICG. The complexity of endovascular catheter- fistula. ization should be well understood when intraoperative localization of these lesions can be so well executed in the modern operating room. Disclosure The authors have no personal, financial, or institutional interest in any of the Babu G. Welch drugs, materials, or devices described in this article. Dallas, Texas OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 3 | MARCH 2018 | 313 Downloaded from https://academic.oup.com/ons/article-abstract/14/3/313/3863094 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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