Precision Mapping: Intraoperative Indocyanine-Green Video Angiography in Thoracic Spinal Dural Arteriovenous Fistula, The Surgical Management: A Case Report

Background: The sudden or gradual onset of bilateral lower limb weakness, coupled with sensory deficits and alteration in reflex activity, should give rise to significant concern for potential emergent spinal conditions. The common spinal pathologies that we usually encounter are spinal cord compression, trauma, cauda equina syndrome, and Guillain-Barré syndrome. Conversely, there is a rare condition known as Foix-Alajouanine syndrome, which manifests with a wide spectrum of neurological symptoms originating from spinal vascular malformations. The formation of spinal dural arteriovenous fistula (dAVF) represents a prominent manifestation of Foix-Alajouanine syndrome. Case Presentation: We report an uncommon case of thoracic spinal dural arteriovenous fistula (dAVF) managed through microsurgery with intraoperative Indocyanine-Green (ICG) video angiography assisted in a 37-year-old gentleman. This is a complex case, as the usual endovascular approach was not feasible due to the torturous configuration of the arterial feeder vessels. Our patient showed no neurological improvement during the 1st and 3rd-month follow-up evaluations, presumably owing to the delayed onset of the condition. Prolonged monitoring may unveil amelioration in our patient's symptoms. Conclusion: Foix-Alajouanine syndrome, albeit uncommon, merits attention in cases of progressive myelopathy. Microsurgical intervention for spinal dural arteriovenous fistula (dAVF), complemented by intraoperative ICG video angiography, is an efficacious treatment strategy. Timely intervention is crucial for favorable outcomes.