Vascular orientation by intra-arterial dye injection during spinal arteriovenous malformation surgery: Technical note

OBJECTIVE: Rich and complicated vascular structures on the spinal cord ofte n interfere with obliteration of a spinal arteriovenous malformation (AVM). Vascular orientation during spinal AVM surgery is essential. The authors r ecently performed six consecutive spinal AVM surgeries in five patients (tw o with perimedullary AVMs, and three with dural arteriovenous fistulae) wit h the aid of intra-arterial injection of dye (indigo carmine). METHODS: Two representative cases are described. A microcatheter was placed preoperatively in the artery of interest. Subsequent to the exposure of th e vascular complex, a 1-ml injection of indigo carmine (2 mg/ml) clearly de monstrated the feeding arteries and the draining veins around the AVM or du ral arteriovenous fistula. RESULTS: One patient had repeat surgery because of incomplete obliteration of the AVM owing to migration of the catheter. All patients, except one who had temporary postoperative deterioration and persistent neurological defi cits, had good surgical outcomes, however. No apparent side effects caused by the dye were reported. CONCLUSION: The assistance system for spinal AVM surgery is easy and safe a nd can be applied in other surgical institutions.