Resection of ruptured spinal pial arteriovenous fistula under ultrasound control: how I do it.

BACKGROUND: Spinal pial arteriovenous fistulae are rare intradural superficial vascular lesion consisting in a direct shunt between spinal pial arteries and veins. The presentation of pial arteriovenous fistula is caused by venous congestion with spinal cord ischemia, mass effect, or hemorrhage. The treatment is surgery or endovascular procedure. METHODS: We illustrate the case of thoracic pial arteriovenous fistula in a 66-year-old female operated with posterior midline approach and B-mode US. CONCLUSION: Posterior midline approach with targeted laminotomy using high-speed drill affords an ideal surgical exposure. B-mode US is helpful to detect the fistula and study their relationship with the surrounding structures.