title: The validity of intraoperative angiography for the treatment of spinal arteriovenous fistula.
abstract: METHODS
  Retrospective study of patients with spinal arteriovenous fistula (AVF) who underwent surgical treatment.
  
  
  OBJECTIVE
  To evaluate the validity of the intraoperative angiography (IA) for the surgical treatment of spinal AVF.
  
  
  BACKGROUND
  Owing to the development of interventional techniques, endovascular embolization has become the treatment of choice for AVF, but it is not applicable for every spinal AVF owing to anatomic complexity of the spinal cord vessels. To get effective occlusion of the AVF, IA has been routinely used in the management of cerebral vascular diseases, but report of its use for spinal AVF is rare.
  
  
  METHODS
  Since 2004, 4 consecutive cases of spinal AVF (3 males and 1 female, 3 thoracic, and 1 thoracolumbar) were involved in this study. The mean age at the time of operation was 62.3 years (range from 48 to 76 y). Types of AVFs and surgical techniques were reviewed retrospectively and the outcomes were assessed using the Japanese Orthopedic Association scoring system.
  
  
  RESULTS
  AVFs in 3 patients were diagnosed as the dural type and that in the remaining patient as the perimedullary type; all feeding arteries were derived from the ninth to 10th intercostal arteries. Preoperative angiography demonstrated that the feeding arteries in 2 patients with a dural AVF were the branches of Adamkiewicz artery and in another dural AVF case, the Adamkiewicz artery could not be determined, therefore, endovascular embolization was not feasible. Including a patient with perimedullary AVF, a microsurgical clipping combined with IA was selected as the treatment. Complete occlusion of the fistula was achieved in all cases, the mean preoperative Japanese Orthopedic Association score of 4.5 improved to 6 at the final follow-up, and no perioperative complications were observed during the follow-up period.
  
  
  CONCLUSIONS
  The favorable clinical results in our spinal AVF cases confirmed that IA ensures safe and accurate occlusion of the fistula. This technique provides satisfactory surgical results for spinal AVFs.
authors.affiliation: Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
authors.forename: Yingpeng
authors.initials: Y
authors.lastname: Xia
authors.forename: Ken
authors.initials: K
authors.lastname: Ishii
authors.forename: Masaya
authors.initials: M
authors.lastname: Nakamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Onozuka
authors.forename: Ryo
authors.initials: R
authors.lastname: Ueda
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Chiba
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013116:Spinal Cord / Q000002:abnormalities* / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome