Dr. Ali Bydon Performs A Spinal Cord AV Fistula Repair
Hello, I am Dr. Ali Bydon. A neuro surgeon specializing in the treatment of spinal disorders at Johns Hopkins University. I wanted to share with you a video illustration of the surgical treatment, of a rare condition that can present and cause intrigue to the spinal cord, and possibly paralysis. And that is spinal cord vascular malformation. The following video is of an operation that we performed in conjunction with Dr.
Rafael Tamargo, the Walter Dandy distinguished Professor of Neurosurgery at our institution. The following is the video. A patient is placed on their stomach the posterior back area is incised. The bone that surrounds the spinal cord has been removed and you can see here that the dura is exposed, and underneath the dura lies the spinal cord. So, the dura is the layer that surrounds the spinal cord. The spinal cord is now exposed, and we are removing the last layer between the spinal cord and the dura, which is the arachnoid as we are opening that up. [BLANK_AUDIO] You can see that there's a large vessel that is asymmetric and only present on one size. We have isolated the A feeding vessel into that vein and here you can see a placement of clips in order to interrupt the, the abnormal flow of blood into that vein.
We this procedure is done under neuro monitoring. The spinal cord is monitored in order to ensure that this was not a prominent supplier of blood to the spinal cord. Clipping a prominent supplier of blood to the spinal cord would lead to paralysis. You can see that these are temporary clips which are used. This is followed by injection of A material that would light up the vessels in order to confirm the complete resolution of the fistulas connection.
Here, I am trying to show you the other side which has a normal small sized vessel as compared to the side where we placed the clips which has the large abnormal vessel. And this is the asymmetry that helps us tell what side we, the operation needs to be performed on. [BLANK_AUDIO] This is the dye which is injected into the vessel in order to confirm that the fistulas connection is no longer present. And at this point, you can see us, now that we have documented that is not a, an important vessel and that removal of the fistulas abnormal connection. Will not amount lead to neurological deficit, as the patient did not have any changes on the neuro monitoring, which was done intraoperatively.
You can see us bipolaring or cooking the vessel, and interrupting the fistulas connection, permanently. [blank_audio].
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