Spinal Dural Arteriovenous Fistula: Is There A Role For Intra-operative Contrast Enhanced Ultrasound?

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Spinal Dural Arteriovenous Fistula: Is There A Role For Intra-operative Contrast Enhanced Ultrasound?

World Neurosurg. 2017 Jan 19;:

Authors: Prada F, Del Bene M, Faragò G, DiMeco F

Abstract
BACKGROUND: Intra-operative imaging during surgical ligation of a spinal dural arteriovenous fistula (SDAVF) is usually based on fluorescence angiography, intra-operative ultrasound with Doppler modality and intra-operative digital subtraction angiography. The aim of our work was to explore the potential role of contrast enhanced ultrasound (CEUS) during surgical management of SDAVF. SDAVF main features in CEUS prior to treatment are described together with their modifications after surgical ligation Case Description CEUS was performed using harmonic imaging with a second generation ultrasound contrast agent (SonoVue) in a case of right D6 spinal dorsal arterio-venous fistula. An initial CEUS scan demonstrated the location of the arterialized vein draining in the dilated peri-medullary plexus together with an augmented enhancement of the spinal cord because of intra-medullary capillary congestion and augmented flow. The post-ligation scan demonstrated the interruption of the arterialized vein together with normal blood flow restoration in spinal cord and in peri-medullary plexus.
CONCLUSIONS: CEUS allowed both pre- and post-ligation real-time visualization of site of the fistula and blood flow changes occurring in the spinal cord and peri-medullary plexus. In our opinion CEUS is definitely a valuable tool in SDAVF surgery, that encompass limitations of Doppler imaging and that might be integrated with other imaging modalities such as fluorescence.

PMID: 28111313 [PubMed - as supplied by publisher]

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