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

    Final Number:

    Francesco Prada MD; Massimiliano Del Bene; Giuseppe Faragò; Francesco DiMeco MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: Intraoperative imaging during surgical ligation of a spinal dural arteriovenous fistula (SDAVF) is usually based on fluorescence angiog- raphy, 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.

    Methods: CEUS was performed using harmonic imaging with a second-generation ultrasound contrast agent in a case of right D6 SDAVF.

    Results: 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 liga- tion 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.

    Patient Care: In vascular malformations such as SDAVFs, CEUS shows the angioarchitecture and blood flow features with great spatial and temporal resolution without the limitations of artifacts and dependence of the angle of insonation, facilitating surgical maneuvers and understanding of physiology as demonstrated in this case.

    Learning Objectives: To understand the potential benefits of intraoperative contrast-enhanced ultrasound (CEUS) application in SDAVF surgery, presenting principal features before treatment and the modifications after surgical ligation.


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