In situ photocoagulation of spinal dural arteriovenous malformations using the Nd:YAG laser

Spinal dural arteriovenous malformations (AVM's) are the most common type of AVM involving the spinal cord in adults. Direct obliteration of the fistula nidus located in the dura is the preferred method of treatment. Five cases of spinal dural AVM were treated by open surgical exposure, microsurgical disconnection of the dural nidus from the coronal venous plexus, and in situ obliteration of the nidus using the Nd:YAG laser. Use of the Nd:YAG laser reduced nidus obliteration to a simple 10-minute technical exercise. All patients improved neurologically following surgery, and complete obliteration of all lesions was verified by delayed angiography. There were no permanent complications related to either the surgical exposure or the use of the Nd:YAG laser. Open surgical treatment of spinal dural AVM's using the Nd:YAG laser appears to be a safe, effective, and durable method of treating these lesions. Photocoagulation is discussed in the context of the other treatment modalities available.