How I do it: Exoscope assisted microsurgical ligation of type 1 spinal dural arteriovenous fistula.

Abstract

Type 1 Spinal dural arteriovenous fistula (dAVF) is a rare but curable vascular cause of myelopathy. Microneurosurgery is a very efficacious modality in treating them. A 26 year old gentleman with progressive flaccid paraparesis (LMN type) and urinary incontinence underwent surgery using exoscope for a right side T9-10 dAVF. A dilated vein was seen accompanying the exiting nerve root intraoperatively, consistent with the preoperative angiographic findings. The vein was ligated and divided leading to restitution of spinal cord vasculature on table and excellent postoperative outcome. Surgical resection is a straightforward and highly effective treatment in spinal dAVF.