Virtual injection software for endovascular management of spinal dural arteriovenous fistula

Endovascular management of spinal dural arteriovenous fistula (DAVF) is arduous because of complex angioarchitecture and motion artifacts and is limited by the two-dimensional (2D) view. However, cone beam computed tomography (CBCT) acquisitions with selective injections allow 3D multiplanar reconstructions contributing to high diagnostic, anatomical and safety value. In this study, we described the use of virtual injection software (VIS) computed from CBCT acquisition and already used for prostatic and cerebral embolization, for the endovascular management of spinal DAVFs (EmboAssist, GE HealthCare, Chicago, USA). The VIS has been designed to facilitate the analysis of the patient's vasculature during the planning of embolization procedures to define the afferent pedicles to the shunt and the incidence of oblique projection, allowing for a better anatomical understanding and helping for the selection of 2D incidence. Combined with 3D roadmapping, VIS allows vessel tracking for selective catheterism and embolization. The VIS is a useful tool for planification and navigation during endovascular treatment of spinal DAVF with a safety value.