• Rina Di Bonaventura, Lara Brunasso, Carmelo Lucio Sturiale, Iacopo Valente, Alessandro Pedicelli, Enrico Marchese, Rosario Maugeri, Domenico Gerardo Iacopino, Alessandro Olivi, and Alessio Albanese.
• Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy.
• World Neurosurg. 2024 Jul 1; 187: 162169162-169.

BackgroundInterruption of the fistulous point is the goal of treatment of spinal dural arteriovenous fistulas (dAVFs). Microsurgery remains a highly efficient treatment in terms of complete occlusion with the lowest risk of recurrence rate. It is reported that the hardest step involves finding the fistulous site itself, potentially extending surgical access and time and increasing potential postoperative surgical-related complications. The accurate preoperative detection of the shunt and spinal level together is crucial for guiding optimal, fast, and safe microsurgical treatment.MethodsWe describe a preoperative angiographic protocol for achieving a safe and simple resection of spinal dural arteriovenous fistulas based on a 6-year institutional experience of 42 patients who underwent minimally invasive procedures. Two illustrative cases are included to support the technical descriptions.ResultsThe suspected artery associated with the vascular malformation of interest is studied in our angiographic protocol through nonsubtracted selective acquisitions in lateral projection. The resulting frames are reconstructed with three-dimensional rotational angiography. The implementation of the preoperative angiographic protocol allowed 100% of intraoperative identification of the fistulous point in all cases with the use of a minimally invasive approach.ConclusionsNowadays, neurosurgeons advocate for minimally invasive procedures and procedures with low morbidity risk for treatment of spinal dural arteriovenous fistulas. Our preoperative approach for accurate angiographic localization of the fistulous point through nonsubtracted and three-dimensional reconstructed angiography allowed us to achieve safe and definitive occlusion of the shunt.Copyright © 2024 Elsevier Inc. All rights reserved.

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