ArticleJournal of neurosurgery. Case lessons2026
Single-position surgery with intraoperative digital subtraction angiography via a transpopliteal approach for complex spinal vascular lesions: illustrative cases.
Article in Journal of neurosurgery. Case lessons, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIntraspinal vascular lesions, including dural arteriovenous fistulas (DAVFs) and arteriovenous malformations (AVMs), require accurate intraoperative localization and complete obliteration to prevent irreversible neurological deficits. Conventional transfemoral digital subtraction angiography (DSA) is often limited by patient repositioning during spinal surgery. This study describes a single-position technique integrating microsurgical resection with intraoperative DSA via a transpopliteal approach in the prone position. OBSERVATIONS: Three patients (1 AVM, 2 DAVFs) underwent microsurgical treatment with intraoperative DSA through ultrasound-guided left popliteal artery access in a hybrid operating room. Angiography enabled precise localization before durotomy and confirmation of complete obliteration after lesion disconnection without repositioning. Real-time visualization of feeding arteries and draining veins facilitated accurate microsurgical intervention. Intraoperative neurophysiological signals were preserved or improved in all cases. Postoperative MRI and DSA confirmed complete lesion removal and regression of spinal cord edema. No access-related complications were observed, and all patients demonstrated favorable neurological recovery. LESSONS: The single-position transpopliteal intraoperative DSA is a safe and efficient approach for complex spinal vascular lesions. Standardized positioning, risk-based access site selection, and integration of intraoperative neurophysiological monitoring enhance precision and safety. These refinements streamline workflow and support reproducible adoption in advanced spinal vascular surgery. https://thejns.org/doi/10.3171/CASE26156.
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