Fluorescein-guided surgical ablation of spinal dural arteriovenous fistula (SDAVF) is a safe and effective add-on to ensure surgical closure

Introduction: Spinal dural arteriovenous fistula (SDAVF) is the most common subtype of spinal arteriovenous lesions. SDAVF often causes intramedullary edema, resulting in ischemic myelopathy and progressive paraplegia over time. Identifying the SDAVF intraoperatively is not always easy. Fluorescein-guided surgical ablation is a technique developed in our department to visualize the fistula in SDAVF enabling secure surgical closure. Research question: To evaluate the efficiency of fluorescein-guided open surgical ligation treatment of SDAVFs. Material and Methods: Single centre retrospective cohort study. Results: 22 patients (male = 18), 34 - 83 years of age were included. Patients presented with gait disturbance (n=22) balance disturbances (n=20), back pain (n=15), and/or radicular pain to the lower extremities (n=13). Fluorescein-guided surgical ablation was applied peri-operatively in all patients. Successful identification of SDAVF was seen in all patients. One had re-surgery; in this patient the fluorescein-guided was not followed and dural leakage was observed. No complication to the add-on procedure was seen. After treatment, 19 patients experienced either complete remission- or some degree of improvement in gait disturbance (RR=0.86 (95% Confidence interval (CI) 0.65-0.97)), balance disturbances ((RR=0.85 (95%CI 0.62-0.97)), back pain ((RR=0.53 (95%CI 0.27-0.79)), and/or radicular pain ((RR=0.69 (95%CI 0.39-0.91)). Rostro-caudal extent of intramedullary edema on Magnetic resonance imaging was reduced by a mean 161 mm (95%CI 129-194) postoperatively. Discussion and Conclusion: Fluorescein-guided open surgical ablation of SDAVF is safe and seems a low cost effective diagnostic add-on with postoperative clinical- and imaging improvement.