Case reportApplication of fluorescein sodium videoangiography in surgery for spinal arteriovenous malformation

- Fluorescein sodium videoangiography (FLVA) in intra-operative evaluation of conus arteriovenous malformation is useful.
- Identification of early filling vessel and site of fistulous connection possible.
- FLVA is real time, non-invasive, radiation-free, easily reproducible technique.
- It allows surgical manipulation through the operating oculars.
- FLVA is complimentary to indocyanine green videoangiography.

We present our recent experience with fluorescein sodium videoangiography (FLVA) in the intra-operative evaluation of a patient with conus medullaris arteriovenous malformation (AVM). To our knowledge this is the first report in the literature of use of FLVA in the surgery of spinal AVM. Intra-operative FLVA was done to identify an early filling vessel and to obliterate the site of fistulous connection. This was correlated and confirmed with simultaneous indocyanine green videoangiography (ICGVA). The conus and cauda equina roots could be appreciated and manipulated in relation to this fluorescence. Obliteration was confirmed with FLVA and correlated with ICGVA. There was no untoward reaction to the dye injection. We conclude that FLVA is a useful adjunct in the surgical treatment of conus medullaris AVMs since it is a real time, noninvasive, radiation-free, easily reproducible technique allowing surgical manipulation through the operating oculars with simultaneous visualization of surrounding critical structures.