[Direct Surgery for Spinal Arteriovenous Shunt Disease: Indication and Technical Tips].

Spinal arteriovenous(AV) shunt disease is rare, although many neurosurgeons may encounter patients with the disease. Recently, the pathological findings and classification of spinal AV shunt disease have been well described. The fundamental treatment of spinal AV shunt disease involves interruption of the shunt, which is achieved by endovascular treatment or direct surgery. Development in diagnostic imaging and technology for endovascular treatment has enabled us to treat many cases. Recently, several multicenter studies on spinal AV shunt diseases revealed that the treatment outcomes of direct surgery were better than those of endovascular treatment. However, in our institute, endovascular treatment is the first line because it is less invasiveness. Although the success and complication rates of endovascular treatment are inferior to those of direct surgery, endovascular treatment remains a therapeutic option for patients with spinal AV shunt disease if it could achieve low complication rates and direct surgery could be performed afterward to rescue the patient. In this article, we elaborate on this disease, surgical indications, limitations of endovascular treatment, and tips for direct surgery.