scholarly journals P.119 Minimally invasive surgical disconnection of a spinal dural arteriovenous fistula with the use of intraoperative digital subtraction angiography

2016 ◽  
Vol 43 (S2) ◽  
pp. S47-S48
Author(s):  
MD Staudt ◽  
B Wang ◽  
SP Lownie
Keyword(s):  
Minimally Invasive ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Thoracic Myelopathy ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Minimally Invasive Surgical ◽  
Femoral Puncture ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Open Surgical Approach

Background: Spinal dural arteriovenous fistulas (dAVF) are a significant but treatable cause of progressive myelopathy. The goal of treatment is disconnection of the fistula, which is often accomplished through an open surgical approach. We report two cases using a minimally invasive surgical (MIS) approach for dAVF ligation with intraoperative digital subtraction angiography (DSA) to confirm occlusion. Methods: Case report. Results: Two patients presented with progressive thoracic myelopathy and were identified to have fistulous connections at the left L1 and T8 levels respectively. Intraoperatively, a left femoral puncture was performed and a 5-French (40 cm) sheath was inserted. Patients were positioned prone and intraoperative spinal DSA was performed using the Siemens Zeego. Once the feeding radicular artery was visualized, image overlay and cross-hair laser was used to trace and localize the fistulous zone. A unilateral single level MIS hemi-laminectomy was performed. The fistulous zone and accompanying nerve root were exposed and small hemostatic clips were applied followed by surgically disconnection. Finally, intraoperatively video angiography as well as spinal DSA were performed for confirmation. Conclusions: MIS disconnection with intraoperative DSA is a safe and effective technique for treating spinal dAVFs. Patients benefit from quicker recovery and shorter hospital stay.

Accuracy and pitfalls of multidetector-row computed tomography in detecting spinal dural arteriovenous fistulas

2010 ◽  
Vol 12 (3) ◽  
pp. 243-248 ◽  
Author(s):  
Satoshi Yamaguchi ◽  
Tetsuya Nagayama ◽  
Kuniki Eguchi ◽  
Masaaki Takeda ◽  
Kazunori Arita ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Nerve Root ◽  
Multidetector Row Computed Tomography ◽  
Digital Subtraction ◽  
Selective Angiography ◽  
Multidetector Row ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

Object The purpose of this study was to evaluate the accuracy of multidetector-row CT angiography (MDCTA) in demonstrating spinal dural arteriovenous fistulas (SDAVFs). Methods The authors studied 10 patients with SDAVFs, including 2 with spinal epidural AVFs, who underwent preoperative MR imaging, MDCTA, and digital subtraction angiography (DSA). In the evaluation of coronal sections of multiplanar reformation MDCTA images, inspection was focused on the presence of the following findings: 1) dilated perimedullary veins in the spinal canal; 2) focal enhancement of the nerve root, suggesting the location of the AVF, around the dural sleeve; and 3) a radicular vein that drains the AVF into perimedullary veins. The utility of MDCTA was assessed by comparing its findings with those of DSA in each case. Results Digital subtraction angiography confirmed that the AVFs were located in the thoracic spine in 4 patients and in the lumbar spine in 6 patients, and MDCTA detected dilated perimedullary veins in all 10 patients. In 8 patients, there was focal enhancement of the nerve root. The radicular vein that drains the AVF into the perimedullary veins was found in 8 cases. In 8 cases, the MDCTA-derived level and side of the AVF and its feeder corresponded with those shown by DSA. In 2 patients, however, the MDCTA-derived side of the feeder was on the side contralateral to the feeding artery confirmed by DSA. These lesions were interpreted as spinal epidural AVFs with perimedullary drainage. In 2 cases, MDCTA could not detect the multiplicity of their feeders. Conclusions The use of MDCTA preceding DSA can be helpful to focus the selective catheter angiography on certain spinal levels. However, one should keep in mind that epidural AVFs with perimedullary drainage may resemble SDAVFs and also that MDCTA cannot exclude the possibility of multiple feeders. Further research should elucidate how broadly selective angiography should explore around the MDCTA-suggested target.

scholarly journals P.050 Minimally invasive disconnection of spinal dural arteriovenous fistulas in a hybrid neurovascular operating room

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
SP Lownie ◽  
H Wang ◽  
F Haji ◽  
MR Boulton
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Spinal Dural Arteriovenous Fistula ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
3D Angiography ◽  
Image Overlay ◽  
Vascular Neurosurgery ◽  
Spinal Dural Avf ◽  
Spinal Dural Arteriovenous Fistulas

Background: Hybrid neurovascular operating rooms offer significant advantages for vascular neurosurgery. In 2008, we installed North America’s first robotic intraoperative rotational 2D/3D angiography unit in a neurosurgery operating room. To date, 200 procedures have been performed. Methods: In selected cases of spinal dural arteriovenous fistula (dAVF)requiring surgical disconnection, intraoperative spinal angiographic roadmapping, angiographic image overlay onto the skin and surgically exposed spine, and laser cross-hair image guidance were utilized to accurately determine the location and trajectory of the draining vein. Results: In four cases of spinal dAVF, a minimally invasive approach was employed, via either single-level (N=2) or two-level (N=1) hemilaminectomy. Techniques used included: angiographic roadmap / image overlay and intraoperative fluoroscopic with laser light guidance. These provided sub-centimeter accuracy in localizing the path of the draining vein. Surgical incision lengths ranged between 4 to 5 cm, with the shortest incision measuring only 4.2 cm. Complete cure was obtained in all cases, with no untoward complications. Conclusions: Hybrid neurovascular operating room technology can facilitate the use of minimally invasive approaches to spinal dural AVF disconnection.

scholarly journals Four-dimensional digital subtraction angiography for exploration of spinal cord vascular malformations: preliminary experience

2020 ◽  
Vol 13 (1) ◽  
pp. 69-74
Author(s):  
Frédéric Clarençon ◽  
Stéphanie Lenck ◽  
Eimad Shotar ◽  
Anne-Laure Boch ◽  
Etienne Lefevre ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Digital Subtraction ◽  
Drainage Pattern ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Precise Understanding ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Spinal Epidural

BackgroundThe precise understanding of the angioarchitecture of spinal vascular malformations (SVMs) is often difficult to reach with conventional digital subtraction angiography (DSA). The purpose of our study was to evaluate the potential of four-dimensional DSA (4D-DSA) (Siemens Healthcare) in the exploration of SVMs.MethodsWe retrospectively studied all patients who underwent spinal DSA, including 4D-DSA acquisition, from July 2018 to June 2019 at a single institution. All spinal DSA acquisitions were performed under general anesthesia. 4D-DSA acquisitions were acquired with the protocol '12 s DSA Dyna4D Neuro'. 12 mL of iodixanol 320 mg iodine/mL were injected via a 5 F catheter (1 mL/s during the 12 s 4D-DSA acquisition). Inter-rater (three independent reviewers) and intermodality agreements were assessed.ResultsNine consecutive patients (six men, three women, mean age 55.3±19.8 years) with 10 SVMs (spinal dural arteriovenous fistulas n=3, spinal epidural arteriovenous fistulas n=2, spinal pial arteriovenous fistulas n=2, and spinal arteriovenous malformations n=2; one patient had two synchronous pial fistulas) had spinal DSA, including 4D-DSA acquisition. Inter-rater agreement was good and moderate for the venous drainage pattern and the SVM subtype, respectively. In 9 of 10 cases, the quality of the acquisition was graded as good. Satisfactory concordance between 4D-DSA and the selective microcatheterization was observed in 90% of cases for the location of the shunt point.Conclusion4D-DSA acquisition may be helpful for a better understanding of the angioarchitecture of SVMs. Larger series are warranted to confirm these preliminary results.

Spinal dural arteriovenous fistulas and intrathecal venous drainage: correlation between digital subtraction angiography, magnetic resonance imaging, and clinical findings

2012 ◽  
Vol 16 (5) ◽  
pp. 433-440 ◽  
Author(s):  
Steven W. Hetts ◽  
Parham Moftakhar ◽  
Joey D. English ◽  
Christopher F. Dowd ◽  
Randall T. Higashida ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Functional Status ◽  
Digital Subtraction Angiography ◽  
Vertebral Body ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Mri Studies ◽  
Dural Arteriovenous Fistulas ◽  
Vessel Enhancement ◽  
Spinal Dural Arteriovenous Fistulas

Object Spinal dural arteriovenous fistulas (SDAVFs) cause myelopathy through arterialization of the perimedullary venous plexus and venous congestion of the spinal cord. The authors hypothesized that the craniocaudal extent of engorgement of intrathecal draining veins between the fistula site and the point of drainage out of the thecal sac correlates with the degree of myelopathy. Methods A retrospective review of the authors' institution's radiology databases identified 31 patients with SDAVFs who had undergone digital subtraction angiography (DSA) and MRI examinations of the spine. The authors counted the number of vertebral body levels of spinal cord enhancement and intrathecal vessel enhancement on T1-weighted postcontrast MRI studies. They also counted the number of levels of cord hyperintensity and intrathecal flow voids on T2-weighted MRI studies. On DSA, the authors identified the number of vertebral body levels of dilated intrathecal draining veins and outflow points from intrathecal veins to epidural veins. Functional status of the patients at the time of diagnosis was assessed using the Aminoff-Logue scale (ALS). Results Enlargement of the intrathecal draining veins averaged 10 ± 7.7 spinal levels on DSA. Patients with enlarged draining veins extending 10 or more spinal levels on DSA had worse ALS scores (mean gait 3.4, mean micturition 1.5) than patients with draining veins extending fewer than 10 levels (mean gait 1.8, mean micturition 0.6; p = 0.009 and 0.02, respectively). The number of vertebral body levels of enlarged draining veins correlated with the ALS score (gait r = 0.42, p = 0.009; and micturition r = 0.55, p = 0.0006). More extensive enlarged draining veins were associated with more spinal cord T2 hyperintensity, T2 intrathecal flow voids, and T1 vessel enhancement but not cord enhancement. Conclusions The craniocaudal extent of enlarged intrathecal veins draining SDAVF correlates with patient functional status, providing further insight into the pathophysiology of venous hypertensive myelopathy.

scholarly journals Minimally Invasive Monitoring of Chronic Central Venous Catheter Patency in Mice Using Digital Subtraction Angiography (DSA)

PLoS ONE ◽  
2015 ◽  
Vol 10 (6) ◽  
pp. e0130661 ◽  
Author(s):  
Giovanna Figueiredo ◽  
Teresa Fiebig ◽  
Stefanie Kirschner ◽  
Omid Nikoubashman ◽  
Lisa Kabelitz ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Minimally Invasive ◽  
Digital Subtraction Angiography ◽  
Venous Catheter ◽  
Invasive Monitoring ◽  
Digital Subtraction ◽  
Central Venous ◽  
Catheter Patency

scholarly journals Acute Brainstem Dysfunction Caused by Cavernous Sinus Dural Arteriovenous Fistula

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Yuwa Oka ◽  
Kenichi Komatsu ◽  
Soichiro Abe ◽  
Naoya Yoshimoto ◽  
Junya Taki ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Cavernous Sinus ◽  
Dural Arteriovenous Fistula ◽  
Inflammatory Diseases ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Ocular Symptoms ◽  
Brainstem Dysfunction

Symptoms of cavernous sinus dural arteriovenous fistula depend on the drainage patterns and are very diverse. Among these, brainstem dysfunction is a rare but serious complication. Here, we describe a case with isolated and rapidly progressive brainstem dysfunction due to cavernous sinus dural arteriovenous fistula. An 80-year-old woman presented with a 2-day history of progressive gait disturbance. Neurological examination revealed mild confusion, dysarthria, and left hemiparesis. Magnetic resonance imaging (MRI) revealed pontine swelling without evidence of infarction. Magnetic resonance angiography suggested a faint abnormality near the cavernous sinus. Dural arteriovenous fistula was suspected, and digital subtraction angiography was planned for the next day. Her condition had progressed to coma by the next morning. Pontine swelling worsened, and hyperintensity appeared on diffusion-weighted imaging. Digital subtraction angiography revealed a right-sided cavernous sinus dural arteriovenous fistula with venous reflux into the posterior fossa. Orbital or ocular symptoms had preceded brainstem symptoms in all nine previously reported cases, but brainstem symptoms were the only presentation in our case, making the diagnosis difficult. Some dural arteriovenous fistulas mimic inflammatory diseases when the clinical course is acute. Prompt diagnosis using enhanced computed tomography or MRI and emergent treatment are needed to avoid permanent sequelae.

Intra-Operative Digital Angiography as a Control of the in Situ Saphenous Vein By-Pass Grafts

1988 ◽  
Vol 29 (6) ◽  
pp. 645-648 ◽  
Author(s):  
M. Kehler ◽  
U. Albrechtsson ◽  
A. Alwmark ◽  
H. Lárusdottír ◽  
E. Ribbe ◽  
...  
Keyword(s):  
Digital Subtraction Angiography ◽  
Saphenous Vein ◽  
Digital Angiography ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas

Forty-two patients undergoing in situ saphenous vein by-pass grafting procedures, in two patients bilaterally, were examined intra-operatively with digital subtraction angiography. In 19 (43%) of the examinations the graft and the anastomoses appeared adequate. In 8 cases (18%) significant abnormalities were found, including stenoses (11 %), deficient anastomoses (5%) and graft kinking (2%). Remaining arteriovenous fistulas were found in 17 patients (39%). In most cases immediate correction was possible avoiding later re-operation. At follow up 11 of the 44 grafts were occluded, 10 of these during the first five months and of these five during the first week.

scholarly journals Paraplegia after contrast media application: a transient or devastating rare complication? Case report

2016 ◽  
Vol 24 (5) ◽  
pp. 806-809 ◽  
Author(s):  
Dorothee Mielke ◽  
Kai Kallenberg ◽  
Marius Hartmann ◽  
Veit Rohde
Keyword(s):  
Spinal Cord ◽  
Case Report ◽  
Contrast Media ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Dural Arteriovenous Fistula ◽  
Rare Complication ◽  
Digital Subtraction ◽  
Spinal Dural Arteriovenous Fistula ◽  
The Individual

The authors report the case of a 76-year-old man with a spinal dural arteriovenous fistula. The patient suffered from sudden repeated reversible paraplegia after spinal digital subtraction angiography as well as CT angiography. Neurotoxicity of contrast media (CM) is the most probable cause for this repeated short-lasting paraplegia. Intolerance to toxicity of CM to the vulnerable spinal cord is rare, and probably depends on the individual patient. This phenomenon is transient and can occur after both intraarterial and intravenous CM application.

Evolving Role of Digital Subtraction Angiography in Neurosurgical Practice

Neurosurgery ◽  
1982 ◽  
Vol 11 (3) ◽  
pp. 430-438 ◽  
Author(s):  
Thomas A. Duff ◽  
Patrick A. Turski ◽  
Joseph F. Sackett ◽  
Charles M. Strother ◽  
Andrew B. Crummy
Keyword(s):  
Digital Subtraction Angiography ◽  
Digital Processing ◽  
Initial Assessment ◽  
Digital Subtraction ◽  
Arteriovenous Fistulas ◽  
Pathological Conditions ◽  
Vascular Bypass ◽  
Intracranial Vasculature

Abstract Advances in digital subtraction angiography (DSA) have allowed the evaluation of a number of pathological conditions involving the extra-and intracranial vasculature. In addition to its role in diagnosis. DSA has been used for the postoperative assessment of endarterectomy, aneurysm clipping, and vascular bypass and for the follow-up of arteriovenous fistulas or malformations. This paper describes the theory and anticipated improvements in the digital processing of radiological information and presents our initial assessment of its clinical utility.

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