Spinal Dural Arteriovenous Fistula: Is There a Role for Intraoperative Contrast-Enhanced Ultrasound?

Abstract

BACKGROUND:

Intraoperative imaging during surgical ligation of a spinal dural arteriovenous fistula (SDAVF) is usually based on fluorescence angiography, intraoperative Doppler ultrasound, and intraoperative digital subtraction angiography. We investigated the potential role of contrast-enhanced ultrasound (CEUS) during surgical management of SDAVF. The main features of SDAVF on CEUS before treatment are described as well as their modifications after surgical ligation.

CASE DESCRIPTION:

CEUS was performed using harmonic imaging with a second-generation ultrasound contrast agent in a case of right D6 SDAVF. Initial CEUS scan demonstrated the location of the arterialized vein draining in the dilated perimedullary plexus and augmented enhancement of the spinal cord secondary to intramedullary capillary congestion and augmented flow. The postligation scan demonstrated interruption of the arterialized vein and restoration of normal blood flow in spinal cord and perimedullary plexus.

CONCLUSIONS:

CEUS allowed real-time visualization before and after ligation of the site of the fistula and blood flow changes occurring in the spinal cord and perimedullary plexus. CEUS is a valuable tool in SDAVF surgery without the limitations of Doppler imaging and possibly can be integrated with other imaging modalities such as fluorescence angiography.

• Authors: Francesco Prada, Massimiliano Del Bene, Giuseppe Faragò, Francesco DiMeco
• Journal: World neurosurgery (World Neurosurg) Vol. 100 Pg. 712.e15-712.e18 (Apr 2017) ISSN: 1878-8769 [Electronic] United States
• PMID: 28111313 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2017 Elsevier Inc. All rights reserved.

Chemical References

• Contrast Media

Topics

• Aged
• Central Nervous System Vascular Malformations (diagnostic imaging, surgery)
• Contrast Media
• Humans
• Ligation
• Male
• Neurosurgical Procedures
• Spinal Cord (blood supply, diagnostic imaging, surgery)
• Ultrasonography, Interventional