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

## TL;DR

Fluorescein-guided surgery helps safely and effectively close spinal dural arteriovenous fistulas, improving patient outcomes.

## Contribution

Fluorescein-guided ablation is introduced as a safe and effective add-on technique for SDAVF surgical closure.

## Key findings

- Fluorescein-guided surgery successfully identified SDAVFs in all 22 patients.
- Postoperative imaging showed a mean reduction of 161 mm in intramedullary edema.
- Fluorescein-guided surgery was associated with clinical improvement in gait, balance, and pain.

## Abstract

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.

To evaluate the efficiency of fluorescein-guided open surgical ligation treatment of SDAVFs.

Single centre retrospective cohort study.

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.

Fluorescein-guided open surgical ablation of SDAVF is safe and seems a low cost effective diagnostic add-on with postoperative clinical- and imaging improvement.

•Fluorescein allows real-time visualization of Spinal Dural Arteriovenous Fistulas•Fluorescein confirms complete closure of Spinal Dural Arteriovenous Fistulas•Fluorescein-guided Spinal Dural Arteriovenous Fistulas surgery improves outcomes•Fluorescein-guided Spinal Dural Arteriovenous Fistulas surgery is safe and low-cost

Fluorescein allows real-time visualization of Spinal Dural Arteriovenous Fistulas

Fluorescein confirms complete closure of Spinal Dural Arteriovenous Fistulas

Fluorescein-guided Spinal Dural Arteriovenous Fistulas surgery improves outcomes

Fluorescein-guided Spinal Dural Arteriovenous Fistulas surgery is safe and low-cost