Hybrid open-endovascular onyx embolization of spinal type IVb perimedullary spinal arteriovenous fistula through direct posterior spinal vein access: A case report.

Autor:	Andrade de Almeida RA; Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, United States., Call-Orellana F; Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, United States., Young CC; Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, United States., Rubino F; Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, United States., Thrower SL; Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, United States., Chen SR; Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, United States., North RY; Department of Neurosurgery, University of Texas MD Anderson Cancer Center, Houston, United States.
Jazyk:	angličtina
Zdroj:	Surgical neurology international [Surg Neurol Int] 2024 Sep 27; Vol. 15, pp. 343. Date of Electronic Publication: 2024 Sep 27 (Print Publication: 2024).
DOI:	10.25259/SNI_384_2024
Abstrakt:	Background: Spinal arteriovenous fistulas (SAVFs) are direct communication between arteries and veins without intervening abnormal vessel nidus, which often results in venous congestion and spinal cord dysfunction. Ventrally located SAVF can be challenging to treat through traditional open or endovascular approaches. Case Description: We describe a hybrid (open/endovascular) procedure in a 72-year-old male with a Takai Type IVb SAVF presenting with paraparesis and sphincter dysfunction. Imaging revealed a conus medullaris SAVF in which the main fistulous connection was located ventrally. The conventional endovascular approach was deemed risky, and open surgery failed in the first attempt. The SAVF was resolved using a hybrid approach: under direct visualization, an engorged dorsal vein was punctured with an Angiocath, and a fluoroscopy-guided microcatheter was advanced through it to reach and embolize the ventral perimedullary fistulous connection. After surgery, his progressive neurological decline stabilized, radiographic spinal cord edema improved, and follow-up angiography confirmed obliteration of the fistula. Neurological function remained at the preoperative baseline. Conclusion: This approach may be a treatment for selected cases of type IVb SAVF. Easily accessible feeding vessels are coagulated and cut; the inaccessible ones can be embolized endovascularly during the same procedure. Competing Interests: There are no conflicts of interest. (Copyright: © 2024 Surgical Neurology International.)
Databáze:	MEDLINE
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