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Case Reports
. 2015 Jun 9:6:99.
doi: 10.4103/2152-7806.158458. eCollection 2015.

Minimal access microsurgical ligation of spinal dural arteriovenous fistula with tubular retractor

Anderson Chun On Tsang  1 , Philip Yat Hang Tse  1 , Grace Hoi Ting Ng  1 , Gilberto Ka Kit Leung  1
Affiliations
Case Reports

Minimal access microsurgical ligation of spinal dural arteriovenous fistula with tubular retractor

Anderson Chun On Tsang et al. Surg Neurol Int. .

Abstract

Background: Open surgical ligation is an effective treatment of spinal dural arteriovenous fistula (SDAVF). Until recently, the procedure would require an open laminectomy, which may potentially cause significant postoperative pain, spinal deformity, and instability due to disruptions of the spinal mechanics. Development in minimal access spine surgery provides an alternative approach that can minimize bone and soft tissue trauma.

Case description: We report two patients who presented with progressive paraparesis secondary to thoracolumbar SDAVF. Minimal access microsurgical ligation was successfully performed through a tubular retractor using a paramedian muscle-splitting approach.

Conclusion: With accurate localization of the fistulous point in each patient, only a hemilaminectomy and a small dura opening were required using the tube-assisted technique. This allows direct visualization and ligation of the fistulous point while minimizing postoperative morbidities.

Keywords: Arteriovenous fistula; minimally invasive surgery; spine; tubular retractor.

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Figures

Figure 1
Figure 1
(a) Preoperative T2 magnetic resonance imaging (MRI) of patient 1 showing the serpiginous veins surrounding the thoracic spinal cord most prominent at T7/8 level (arrowed), secondary to the dural arteriovenous fistula (DAVF). (b) Preoperative super-selective angiography of patient 1 showing the DAVF fed by the right T7 radicular artery (arrowed). (c) Preoperative T2 MRI of patient 2 showing the serpiginous veins surrounding the thoracic cord most prominent at T8/9 level (arrowed), secondary to the DAVF. (d) Postoperative T2 MRI of patient 1 showing the resolution of venous engorgement around the thoracic spinal cord (arrowed)
Figure 2
Figure 2
(a) Operative view through the tubular retractor under a surgical microscope, showing dilated serpiginous veins (arrowed) after opening the dura. (b) Dissection of the fistulous point of the spinal dural arteriovenous fistula (arrowed) at the junction of the nerve root sleeve. (c) Water-tight primary dura closure with polypropylene sutures (arrowed)
See this image and copyright information in PMC

References

    1. Geibprasert S, Pereira V, Krings T, Jiarakongmun P, Toulgoat F, Pongpech S, et al. Dural arteriovenous shunts: A new classification of craniospinal epidural venous anatomical bases and clinical correlations. Stroke. 2008;39:2783–94. - PubMed
    1. Kim YB, Hyun SJ. Clinical applications of the tubular retractor on spinal disorders. J Korean Neurosurg Soc. 2007;42:245–50. - PMC - PubMed
    1. Klopper HB, Surdell DL, Thorell WE. Type I spinal dural arteriovenous fistulas: Historical review and illustrative case. Neurosurg Focus. 2009;26:E3. - PubMed
    1. Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30:639–48. - PMC - PubMed
    1. Patel NP, Birch BD, Lyons MK, DeMent SE, Elbert GA. Minimally invasive intradural spinal dural arteriovenous fistula ligation. World Neurosurg. 2013;80:e267–70. - PubMed

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