Microsurgical intraluminal obliteration of type IV perimedullary arteriovenous fistula with an in situ hemostatic agent: illustrative case

BACKGROUNDSpinal arteriovenous fistulas (SAVFs) are underdiagnosed entities that can lead to severe morbidity from spinal cord dysfunction or hemorrhage. Treatment options include endovascular embolization or direct surgical obliteration at the level of the arteriovenous shunt. The authors present a...

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Bibliographic Details
Published in:Journal of neurosurgery. Case lessons 2023-10, Vol.6 (15)
Main Authors: Lara-Reyna, Jacques, Garst, Jonathan R, Winslow, Nolan, Klopfenstein, Jeffrey D
Format: Article
Language:English
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Case Lesson
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Summary:BACKGROUNDSpinal arteriovenous fistulas (SAVFs) are underdiagnosed entities that can lead to severe morbidity from spinal cord dysfunction or hemorrhage. Treatment options include endovascular embolization or direct surgical obliteration at the level of the arteriovenous shunt. The authors present a case of intraluminal microsurgical access for occlusion with a hemostatic agent of a type IV SAVF near the conus medullaris as an alternative to clip occlusion to avoid nerve root compromise.OBSERVATIONSTemporary microsurgical clipping of the SAVF led to nerve root compromise detected via intraoperative monitoring. Instead, the authors advanced elongated pieces of a hemostatic agent directly into the arterial lumen via arteriotomy to create direct obliteration of the fistula without intraoperative monitoring changes.LESSONSIn patients unable to tolerate clipping of the SAVF because of nerve root involvement and neurophysiological signal decline, open access of the vessels and direct intraluminal obliteration using a hemostatic agent should be considered as an alternative method of fistula occlusion.
ISSN:2694-1902
2694-1902
DOI:10.3171/CASE23322