Surgical resection of spinal dural arteriovenous fistula with micro-tubular retractors under CT guidance: cases report and literature review

Liu W, Shengzi Dongye, Yuanqin Liu, 林延大, Feng Li

Objective This case report describes the surgical management of spinal dural arteriovenous fistulas (SDAVFs) using micro-tubular retractors under CT guidance, along with a review and analysis of the relevant literature. Methods The surgical approach involved the use of micro-tubular retractors for a minimally invasive microsurgical technique, guided by CT imaging to treat two cases of spinal dural arteriovenous fistula (SDAVF). The procedure included intraoperative computed tomography (CT) for precise localization of the fistula and indocyanine green angiography to confirm the position and obliteration of the fistula. Preoperative symptoms and postoperative outcomes were documented. Results Complete obliteration of the fistula was achieved in both patients through minimally invasive microsurgery via a micro-tubular retractor. Clinical improvement was observed postoperatively, and no complications related to the surgical procedure were noted. Early postoperative follow-up (during hospitalization) demonstrated no recurrence of the fistula or postoperative complications.Traditional open surgery may compromise spinal stability; however, the use of a micro-tubular retractor significantly mitigates this risk. Conclusion Microsurgery via a micro-tubular retractor under CT guidance is a feasible and effective approach for the surgical treatment of spinal dural arteriovenous fistulas (SDAVFs). This method achieves precise localization and minimizes surgical trauma by reducing damage to muscles, ligaments, and bony structures, thereby shortening postoperative recovery time. However, long-term follow-up and additional cases are needed to further validate the clinical efficacy of this technique.