The role of Surgery in the treatment of spinal Dural Arteriovenous fistula

The vascular abnormality known as a spinal dural arteriovenous fistula (SDAVF) is highly uncommon. To perceive the anomaly, the gold standard before surgical operations like vascular therapy or open surgical procedures involves computerized reduction imaging. Hidden SDAVFs on an angiogram have been documented before. There was no assessment of surgical options for SDAVFs with false-positive angiogram findings. Patients who underwent SDAVF surgery in 2018–2019 at a single institution had their medical records, and imaging trainings revised retrospectively. After failing endovascular embolization or worsening clinically and radiographically in the context of an angiographically hidden lesion, all patients were referred for surgical intervention. Surgery options for these lesions were explored after a thorough case assessment. There was a total of 4 cases in this series. Despite undergoing embolization before surgical repair, the neurological status of 2 patients deteriorated further, while embolization in 2 other patients was unsuccessful due to the complexity of their vascular systems. All four patients had their neurological conditions improve or remain stable after the examination. Microscopically integrated fluorescence angiography with indocyanine green injection helped identify the supplier’s veins and proved the SDAVF closure. After an SDAVF has been identified, immediate treatment is necessary. If angiography results are unclear or raise doubts about the presence of SDAVF, an urgent spinal investigation should be performed. Indocyanine exploring spine surgery for SDAVF completion may benefit from green light micro angiography.