• Giuseppe Maria Della Pepa, Giovanni Sabatino, Carmelo Lucio Sturiale, Enrico Marchese, Alfredo Puca, Alessandro Olivi, and Alessio Albanese.
• Institute of Neurosurgery, Catholic University of Rome, Rome, Italy. Electronic address: gdellapepa@hotmail.com.
• World Neurosurg. 2018 Apr 1; 112: 138-142.

BackgroundIn the surgical treatment of spinal dural arteriovenous fistulas (DAVFs), intraoperative definition of anatomic characteristics of the DAVF and identification of the fistulous point is mandatory to effectively exclude the DAVF.Case DescriptionIntraoperative ultrasound and contrast-enhanced ultrasound integrated with color Doppler ultrasound was applied in the surgical setting for a cervical DAVF to identify the fistulous point and evaluate correct occlusion of the fistula.ConclusionsIntegration of intraoperative ultrasound and contrast-enhanced ultrasound is a simple, cost-effective technique that provides an opportunity for real-time dynamic visualization of DAVF vascular patterns, identification of the fistulous point, and assessment of correct exclusion. Compared with other intraoperative tools, such as indocyanine green videoangiography, it allows the surgeon to visualize hidden anatomic and vascular structures, minimizing surgical manipulation and guiding the surgeon during resection.Copyright © 2018 Elsevier Inc. All rights reserved.

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