1/6: Intraop view of mid-thoracic #spinal #dural #arteriovenous #fistula pre/post disconnection of arterialized vein. While some #DAVF are amenable to #embolization, single-level #laminectomy is a simple and more often #curative approach (link to full #video at end of thread).
2/6: Temporary #clip placement/removal nicely demonstrates direction of #flow in veins (and permits checking intraop SSEP/MEP when necessary).
3/6: Indocyanine green ( #ICG) #fluorescence angiography pre/post disconnection. Arterialized flow no longer seen in #perimedullary #spinal #veins. Note preservation of normal radicular artery just above fistula.
4/6: #Heat map of ICG #fluorescence angiography showing #transit times before and after disconnecting the arterialized vein.
5/6: Catheter angiogram pre/post surgical disconnection. Note preop rapidly ascending/descending #retrograde #leptomeningeal flow, cranial and caudal to site of the fistula. After disconnection, arterialized flow no longer seen in perimedullary spinal veins.
6/6: Short (3 min) #video summarizing steps in #surgical disconnection of a typical #spinal #DAVF, from #dural opening to closure.
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