LIVE, from the Leica Neurovisualization Summit, with “Neurosurgical Treatment of Spinal AV Fistulas”, by Dr. Flueh
AT 12:30 PM CEST, LIVE, HERE, April 21, 2021
Neurosurgical treatment of spinal arterio-venous fistulas – Dr. Flueh
Spinal arterial-venous fistulas are rare, but make up for about 70 % of all spinal vascular malformations and are therefore a relevant disease for interventional neuroradiologists and vascular neurosurgeons. Due to an incidence of 5-10/1.000.000/year spinal dAVFs tend to be underdiagnosed.
Being classified from type 1-4 (Spetzler and Anson), dAFVs are located intradually, extra- and/or intramedullary. The fistula is defined as an arterio-venous shunt between a radiculomeningeal artery and a radicular vein. It is mostly located at the thoracolumbar region.
Symptoms develop gradually in many patients, starting with unspecific symptoms, which tend to progress into a sensomotor paraplegic syndrome. The diagnosis is frequently overseen in MRIs of the spinal cord, and a spinal angiography, which is the diagnostic gold standard, is only performed at neurovascular centers.
Treatment includes interventional embolization of the feeding artery, which might be followed by neurosurgical obliteration via a (partial) hemilaminectomy or interlaminar fenestration. Patients respond to the therapy very well in most cases, and the obliteration rate is high (interventional treatment: 70-90%; operative treatment 98%). A classical pitfall of interventional and neurosurgical treatment options is the correct localization of the artery of Adamkiewicz.
In this Clinical Symposium, Dr. Flueh will give an overview of epidemiology, etiology, diagnosis and treatment of dural arteriovenous fistulas, from a neurosurgeon point of view.
Related Leica Visualization Technologies: M530 OHX microscope, ARveo microscope, FL800
Author: desertedbeach