Kent R. Thielen
We have a long-standing interest and relatively high-volume practice directed at the diagnosis and treatment of spinal dural arteriovenous fistulas (SDAVFs). Patients with an SDAVF frequently have been misdiagnosed or have not been diagnosed at the time of their initial presentation at our institution. The ability to diagnose the patient’s SDAVF and then proceed to the optimal treatment option is significantly enhanced with a very precise understanding of the vascular anatomy, along with the arterial and venous flow characteristics, of the SDAVF. With the initial arrival of 3D C-arm conebeam CT in our angiography suite, we quickly realized that being able to combine the significantly increased spatial resolution of conebeam CT with the optimized vascular contrast opacification of conventional spinal angiography would allow us to increase considerably our ability to precisely localize and define the anatomic relationships of a SDAVF. Our initial experience with applying this innovative approach to defining SDAVFs incrementally improved the anatomic understanding and confidence of both the neuroradiologist and the treating endovascular interventionalist or neurosurgeon. That initial experience prompted us to investigate this technique further.
The ability for the neuroradiologist to personally review the 3D C-arm conebeam CT angiography images with the treating endovascular interventionalist or neurosurgeon has consistently resulted in an improved ability of our practice to provide extremely detailed anatomic understanding of the precise location of the SDAVF along with its anatomic relationship to other soft tissue, bone, or vascular structures. Armed with this improved information our endovascular interventionalists and neurosurgeons can confidently move from diagnosis to the treatment phase of patient care. Essentially all patients with SDAVF diagnosed in our practice undergo 3D C-arm conebeam CT angiography as part of their conventional spinal angiogram.