title: Minimal access microsurgical ligation of spinal dural arteriovenous fistula with tubular retractor.
abstract: BACKGROUND
  Open surgical ligation is an effective treatment of spinal dural arteriovenous fistula (SDAVF). Until recently, the procedure would require an open laminectomy, which may potentially cause significant postoperative pain, spinal deformity, and instability due to disruptions of the spinal mechanics. Development in minimal access spine surgery provides an alternative approach that can minimize bone and soft tissue trauma.
  
  
  METHODS
  We report two patients who presented with progressive paraparesis secondary to thoracolumbar SDAVF. Minimal access microsurgical ligation was successfully performed through a tubular retractor using a paramedian muscle-splitting approach.
  
  
  CONCLUSIONS
  With accurate localization of the fistulous point in each patient, only a hemilaminectomy and a small dura opening were required using the tube-assisted technique. This allows direct visualization and ligation of the fistulous point while minimizing postoperative morbidities.
authors.affiliation: Department of Surgery, Division of Neurosurgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Anderson Chun
authors.initials: AC
authors.lastname: On Tsang
authors.affiliation: Department of Surgery, Division of Neurosurgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Philip Yat
authors.initials: PY
authors.lastname: Hang Tse
authors.affiliation: Department of Surgery, Division of Neurosurgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Grace Hoi
authors.initials: GH
authors.lastname: Ting Ng
authors.affiliation: Department of Surgery, Division of Neurosurgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
authors.forename: Gilberto Ka
authors.initials: GK
authors.lastname: Kit Leung
keywords: Arteriovenous fistula; minimally invasive surgery; spine; tubular retractor