Directional multistage intraoperative microvascular Doppler in the hemilaminectomy surgical obliteration of spinal dural arteriovenous fistular.

Objectives: To present our experience with the use of microvascular Doppler measurement procedure in spinal dural arteriovenous fistula (sDAVF) surgery.

Patients And Methods: All patients with sDAVF from March 2008 to March 2017 who consecutively underwent hemilaminectomy surgical obliteration with the assistance of microvascular Doppler were included. We reviewed patient records, radiological images, operative notes, microvascular Doppler files, as well as intraoperative videos RESULTS: During the study period, 7 patients with sDAVF underwent surgical treatment facilitated by microvascular Doppler. Microvascular Doppler measurement was performed in all enrolled patients. Doppler measurement was reliable to define direction and the value of the flow of sDAVF vessels in all cases, thereby determining the location of fistula and confirming its obliteration. During temporary clip occlusion, Doppler identified successful disconnection in all cases by detecting a disappearance of arterial spectrum flow as well as a significant flow drop in venous drainages between before and after clip. At the final stage of obliteration, disappearance of the arterial spectrum and a significant flow drop in venous drainages was detected in all cases. No microflow probe-induced sDAVF vessel injury was detected. Complete obliteration of sDAVF was achieved in all cases. No recurrence was recorded during follow-up.

Conclusion: Multistage intraoperative microvascular Doppler measurement proved to be a feasible, safe, repeatable, and reliable methodology to assist surgery in different phases of sDAVF obliteration. Further studies are needed to assess the impact of this approach on sDAVF patient outcomes.