Application of hybrid operating rooms for treating spinal dural arteriovenous fistula

Figure 1 Preoperative sagittal MR images, intraoperative angiograms, and intraoperative images obtained in Case 1 with a left T-9 SDAVF treated in hybrid-OR. A and B: Sagittal T2-weighted magnetic resonance images demonstrating typical thoracolumbar spinal cord signal abnormalities associated with the serpiginous dorsal spinal vein; C-E: Digital subtraction angiography (DSA) images demonstrating a left T-9 spinal dural arteriovenous fistula (SDAVF). DSA from left anterior oblique (LAO/Figure 1 D) view showed the S-shaped tortuosity at the beginning of the intercostal artery (black arrow), and DSA from right anterior oblique (RAO/Figure 1 E) view showed that the feeding artery of the SDAVF originating from the intercostal artery was very thin and tortuous (white arrow); F: Intraoperative photographs showing the localization of the fistulae and skin incision using the dual-marker localization technique under flat-panel dynamic fluoroscopy; G and H: Intraoperative photographs showing the SDAVF in exact correspondence with the interoperative DSA images: The spinal cord had a dorsal arterialized vein before clip ligation, and the tension of the dorsal vein decreased after obliteration of the fistula. I: Intraoperative DSA showing that the SDAVF was completely obliterated. DSA: Digital subtraction angiography; SDAVF: Spinal dural arteriovenous fistulas.