Assistance of intraoperative microvascular Doppler in the surgical obliteration of spinal dural arteriovenous fistula: cases description and technical considerations.
BACKGROUND
Intraoperative microvascular Doppler may be valuable in assisting in the surgical obliteration of dural arteriovenous fistula of the spinal cord. It enables identification, through flow spectrum analysis, of the anatomic components and haemodynamic features of this type of vascular malformation.


METHODS
In two cases, intraoperative microvascular Doppler was used to assist in the surgical obliteration of dural arteriovenous fistula of the spinal cord. The fistulas were identified prior to the dura opening, and for this only minimally invasive surgery was required. Direct recordings of the arterialised draining vein and the nidus of the fistula demonstrated a pathological spectrum caused by the arterial supply and the disturbed venous outflow in which a high-resistance flow pattern and low diastolic flow resembling an arterial-like flow velocity were observed.


RESULTS
The fistulas were obliterated by interruption of the draining vein, and Doppler measurements provided information on flow velocity changes in the medullary veins from an arterial to a venous pattern. The absence of any residual flow in the draining vein confirmed successful haemodynamic treatment.


CONCLUSIONS
Intraoperative microvascular Doppler recording is valuable assistance in surgical closure of spinal arteriovenous fistula.
Iacopino
D G
DG
Neurosurgical Clinic, University of Messina School of Medicine, Messina, Italy.
Conti
A
A
Giusa
M
M
Cardali
S
S
Tomasello
F
F
D000368:Aged; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008833:Microcirculation / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D008875:Middle Aged; D015203:Reproducibility of Results; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D018608:Ultrasonography, Doppler