Fluorescein-guided surgery for spinal dural arteriovenous fistulas: A short series

The gold standard treatment of spinal dural arteriovenous fistulas (SDAVF) is surgical exclusion. The main surgical challenge is to localize the origin of the shunting vein and to ensure its complete exclusion. In that context, intra operative angiography technologies have been developed, such as fluorescein video angiography (FVA). The objective of this preliminary study was to assess the utility of FVA in SDAVF surgery through a short surgical series. We retrospectively studied the cases of six patients who had a FVA for a SDAVF. FVA was performed after dural opening and visualization of the suspected shunting vein. In 5 cases, FVA was performed after ligation to ensure the complete exclusion. In 2 cases, FVA was performed before the ligation to confirm the localization of the shunt. In 1 case, FVA was performed before and after ligation. FVA was judged useful in all cases to localize the origin of the shunting vein. FVA permitted to ensure the complete exclusion after ligation. No anaphylactic events were noticed. Our preliminary study suggests that fluorescein video angiography is feasible and helpful for SDAVF surgery.