Considering surgical treatment of spinal dural arteriovenous fistulas, the major difficulty is to localize them reliably during surgery. Usually the affected spinal level is sought by counting of bony structures using fluoroscopy. However, quite frequently, anatomical particularities impede adequate counting resulting in surgery performed at erroneous spinal levels. The objective of this study was therefore to evaluate the potential benefits of preoperative coil marking in order to facilitate intraoperative localization of spinal dural arteriovenous fistulas. After detection of the fistula with spinal angiography, selective catheterization of the feeding vessel was performed, and a GDC coil was detached in the lumen of the vessel adjacent to the respective bony pedicle. Coil marking was effected in 8 patients (group A), 20 patients were operated without such a marking (group B). The data of both groups of patients were compared with regard to accurateness of the surgical approach, duration of surgery, and dosage of intraoperative fluoroscopy. In all patients of group A, the coil was easily identified by intraoperative fluoroscopy. A partial hemilaminectomy was sufficient for localization and microsurgical treatment of the spinal dural arteriovenous fistula in each patient. In patients of group B, the correct spinal level was approached in 12 patients (60%), in 8 patients (40%) surgery was performed initially at an erroneous level (P = 0.048). Mean duration of surgery was 130 min in group A and 177 min in group B (P = 0.031). Likewise, mean dosage of intraoperative fluoroscopy was higher in group B (119.5 vs. 394.3 cGy/cm2; P = 0.036). Preoperative coil marking allows exact intraoperative localization of spinal dural arteriovenous fistulas. Thus, surgery at erroneous spinal levels is avoided, and it is feasible to perform a straightforward, minimally invasive surgical approach. This reflects in significant reduction of duration of anesthesia and surgery. Moreover, radiation exposure of the patient is significantly reduced.
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机译：考虑到脊柱硬脑膜动静脉瘘的手术治疗，主要困难是在手术期间将其可靠定位。通常，通过使用荧光检查法计数骨结构来寻找受影响的脊柱水平。但是，解剖学上的特殊情况经常会妨碍足够的计数，从而导致在错误的脊柱水平进行手术。因此，本研究的目的是评估术前线圈标记的潜在益处，以促进术中脊髓硬脑膜动静脉瘘的定位。在通过脊柱血管造影术检测到瘘管之后，对供血血管进行选择性导管插入术，并在与各个骨蒂相邻的血管腔中分离GDC线圈。在8例患者中进行了线圈标记（A组），没有这种标记的20例患者进行了手术（B组）。比较两组患者的数据，包括手术方法的准确性，手术时间和术中透视的剂量。在A组的所有患者中，通过术中荧光检查很容易识别出线圈。部分半椎板切除术足以对每位患者进行硬脑膜动静脉瘘的定位和显微手术治疗。在B组患者中，有12位患者（60％）达到了正确的脊柱水平，在8位患者（40％）中最初以错误的水平进行了手术（P = 0.048）。 A组的平均手术时间为130分钟，B组的平均手术时间为177分钟（P = 0.031）。同样，B组术中透视的平均剂量较高（119.5 vs. 394.3 cGy / cm 2 ； P = 0.036）。术前线圈标记术可实现术中脊髓硬脑膜动静脉瘘的精确定位。因此，避免了在错误的脊柱水平进行手术，并且可行的是执行直接的，微创的手术方法。这反映出麻醉和手术时间的显着减少。此外，显着减少了患者的辐射暴露。
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