{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:06:50Z","timestamp":1784074010589,"version":"3.55.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","license":[{"start":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T00:00:00Z","timestamp":1783900800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,7,13]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Intraspinal 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE26156\">https:\/\/thejns.org\/doi\/10.3171\/CASE26156<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case26156","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:24Z","timestamp":1784073624000},"source":"Crossref","is-referenced-by-count":0,"title":["Single-position surgery with intraoperative digital subtraction angiography via a transpopliteal approach for complex spinal vascular lesions: illustrative cases"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-4819-0328","authenticated-orcid":true,"given":"Guan-Tze","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0914-8776","authenticated-orcid":true,"given":"Li-Yu","family":"Fay","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2366-1314","authenticated-orcid":true,"given":"Ping-Chuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"},{"name":"Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0550-5855","authenticated-orcid":true,"given":"Tsung-Hsi","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6996-3409","authenticated-orcid":true,"given":"Jau-Ching","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"},{"name":"Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen-Cheng","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5528-204X","authenticated-orcid":true,"given":"Chao-Hung","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei"},{"name":"Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei"},{"name":"PhD Program in Medical Neuroscience, College of Medical Science and Technology, Taipei Medical University, New Taipei City, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"bib1","series-title":"AJNR Am J Neuroradiol","first-page":"639","article-title":"Spinal dural arteriovenous fistulas","volume":"30","author":"Krings","year":"2009","unstructured":"Krings TGeibprasert S.Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30(4):639-648. doi:10.3174\/ajnr.A1485"},{"issue":"3","key":"bib2","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Intramedullary spinal cord \u00adcavernous malformations","volume":"29","author":"Gross","year":"2010","unstructured":"Gross BADu RPopp AJDay AL.Intramedullary spinal cord \u00adcavernous malformations. Neurosurg Focus. 2010;29(3):E14. doi:10.3171\/2010.6.FOCUS10144"},{"issue":"7","key":"bib3","series-title":"Neurol Med Chir (Tokyo)","first-page":"356","article-title":"Spinal arteriovenous shunts: angioarchitecture and historical changes in classification","volume":"57","author":"Takai","year":"2017","unstructured":"Takai K.Spinal arteriovenous shunts: angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo). 2017;57(7):356-365. doi:10.2176\/nmc.ra.2016-0316"},{"key":"bib4","series-title":"Vascular Anatomy of the Spinal Cord: Radioanatomy as the Key to Diagnosis and Treatment","first-page":"137","article-title":"Clinical applications","author":"Thron","year":"2016","unstructured":"Thron AK.Clinical applications. In: Vascular Anatomy of the Spinal Cord: Radioanatomy as the Key to Diagnosis and Treatment. Springer International Publishing; 2016:137-189. doi:10.1007\/978-3-319-27440-9_4"},{"issue":"8","key":"bib5","series-title":"Neurol Med Chir (Tokyo)","first-page":"457","article-title":"Surgical and endovascular treatment for spinal arteriovenous malformations","volume":"56","author":"Endo","year":"2016","unstructured":"Endo TEndo HSato KMatsumoto YTominaga T.Surgical and endovascular treatment for spinal arteriovenous malformations. Neurol Med Chir (Tokyo). 2016;56(8):457-464. doi:10.2176\/nmc.ra.2015-0327"},{"issue":"3","key":"bib6","series-title":"Neurosurgery","first-page":"603","article-title":"Intraoperative spinal digital subtraction angiography: technique and results","volume":"52","author":"Benes","year":"2003","unstructured":"Benes LWakat JPSure UBien SBertalanffy H.Intraoperative spinal digital subtraction angiography: technique and results. Neurosurgery. 2003;52(3):603-609. doi:10.1227\/01.neu.0000047893.56252.ff"},{"issue":"8","key":"bib7","series-title":"J Neurointerv Surg","first-page":"787","article-title":"Intraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review","volume":"15","author":"Muhammad","year":"2023","unstructured":"Muhammad NSioutas GSGajjar AIntraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review. J Neurointerv Surg. 2023;15(8):787-792. doi:10.1136\/jnis-2023-020071"},{"issue":"6","key":"bib8","series-title":"J Neurointerv Surg","first-page":"601","article-title":"Intraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact","volume":"9","author":"Orru\u2019","year":"2017","unstructured":"Orru\u2019 ESorte DEWolinsky JPIntraoperative spinal digital subtraction angiography: indications, technique, safety, and clinical impact. J Neurointerv Surg. 2017;9(6):601-607. doi:10.1136\/neurintsurg-2016-012467"},{"key":"bib9","series-title":"World Neurosurg","first-page":"1","article-title":"Assessment of intraoperative spinal angiography via the popliteal artery for spinal vascular diseases","volume":"169","author":"Maeda","year":"2023","unstructured":"Maeda YMitsuhara TKume SAssessment of intraoperative spinal angiography via the popliteal artery for spinal vascular diseases. World Neurosurg. 2023;169:1-8. doi:10.1016\/j.wneu.2022.10.040"},{"key":"bib10","series-title":"World Neurosurg","first-page":"841","article-title":"Ten-year retrospective study on the management of spinal arteriovenous lesions: efficacy of a combination of intraoperative digital subtraction angiography and intraarterial dye injection","volume":"104","author":"Osanai","year":"2017","unstructured":"Osanai THida KAsano TSeki TSasamori THoukin K.Ten-year retrospective study on the management of spinal arteriovenous lesions: efficacy of a combination of intraoperative digital subtraction angiography and intraarterial dye injection. World Neurosurg. 2017;104:841-847. doi:10.1016\/j.wneu.2017.05.081"},{"issue":"4","key":"bib11","series-title":"Neurosurgery","first-page":"786","article-title":"Microsurgery versus embolization for spinal cord arteriovenous malformations: a proposed grading system","volume":"98","author":"Yu","year":"2025","unstructured":"Yu JLu HKrings TMicrosurgery versus embolization for spinal cord arteriovenous malformations: a proposed grading system. Neurosurgery. 2025;98(4):786-798. doi:10.1227\/neu.0000000000003458"},{"issue":"11","key":"bib12","series-title":"Brain","first-page":"3381","article-title":"The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts","volume":"144","author":"Yu","year":"2021","unstructured":"Yu JXHe CYe MThe efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts. Brain. 2021;144(11):3381-3391. doi:10.1093\/brain\/awab237"},{"key":"bib13","series-title":"World Neurosurg","first-page":"124420","article-title":"Outcomes of surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis","volume":"202","author":"Hafiz","year":"2025","unstructured":"Hafiz BAldahlawi AAshqar AOutcomes of surgical versus endovascular treatment of spinal dural arteriovenous fistula: a systematic review and meta-analysis. World Neurosurg. 2025;202:124420. doi:10.1016\/j.wneu.2025.124420"},{"issue":"8","key":"bib14","series-title":"Spine (Phila Pa 1976)","first-page":"562","article-title":"Comparative efficacy and safety of endovascular versus surgical treatment in spinal dural arteriovenous fistulas: a systematic review and meta-analysis","volume":"50","author":"Musmar","year":"2025","unstructured":"Musmar BRoy JMOrscelik AComparative efficacy and safety of endovascular versus surgical treatment in spinal dural arteriovenous fistulas: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2025;50(8):562-574. doi:10.1097\/brs.0000000000005226"},{"issue":"3","key":"bib15","series-title":"J Neurosurg Spine","first-page":"381","article-title":"Microsurgical versus endovascular treatment of spinal epidural arteriovenous fistulas with intradural venous drainage: a multicenter study of 81 patients","volume":"33","author":"Takai","year":"2020","unstructured":"Takai KEndo TYasuhara TMicrosurgical versus endovascular treatment of spinal epidural arteriovenous fistulas with intradural venous drainage: a multicenter study of 81 patients. J Neurosurg Spine. 2020;33(3):381-391. doi:10.3171\/2020.2.Spine191432"},{"issue":"1","key":"bib16","series-title":"Neurosurg Rev","first-page":"206","article-title":"Surgery versus endovascular treatment for spinal dural arteriovenous fistulas: a multicenter experience and systematic literature review","volume":"47","author":"Zanin","year":"2024","unstructured":"Zanin LDi Bonaventura RAgosti ESurgery versus endovascular treatment for spinal dural arteriovenous fistulas: a multicenter experience and systematic literature review. Neurosurg Rev. 2024;47(1):206. doi:10.1007\/s10143-024-02443-8"},{"issue":"2","key":"bib17","series-title":"Neurosurg Clin N Am","first-page":"193","article-title":"Treatment of spinal arteriovenous malformation and fistula","volume":"33","author":"Ehresman","year":"2022","unstructured":"Ehresman JCatapano JSBaranoski JFJadhav APDucruet AFAlbuquerque FC.Treatment of spinal arteriovenous malformation and fistula. Neurosurg Clin N Am. 2022;33(2):193-206. doi:10.1016\/j.nec.2021.11.005"},{"key":"bib18","series-title":"World Neurosurg","first-page":"e250","article-title":"Recurrence rates following treatment of spinal vascular malformations: a systematic review and meta-analysis","volume":"173","author":"Mamaril-Davis","year":"2023","unstructured":"Mamaril-Davis JAguilar-Salinas PAvila MJDumont TAvery MB.Recurrence rates following treatment of spinal vascular malformations: a systematic review and meta-analysis. World Neurosurg. 2023;173:e250-e297. doi:10.1016\/j.wneu.2023.02.040"},{"issue":"4","key":"bib19","series-title":"Ann Vasc Med Res","first-page":"1045","article-title":"A review of vascular abnormalities of the spine","volume":"3","author":"Singh","year":"2016","unstructured":"Singh RLucke-Wold BGyure KBoo S.A review of vascular abnormalities of the spine. Ann Vasc Med Res. 2016;3(4):1045."},{"issue":"3","key":"bib20","series-title":"J Neurosurg Spine","first-page":"322","article-title":"Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position","volume":"29","author":"Villelli","year":"2018","unstructured":"Villelli NWLewis DMLeipzig TJDeNardo AJPayner TDKulwin CG.Intraoperative angiography via the popliteal artery: a useful technique for patients in the prone position. J Neurosurg Spine. 2018;29(3):322-326. doi:10.3171\/2018.1.Spine171257"},{"issue":"5","key":"bib21","series-title":"Clin Anat","first-page":"347","article-title":"Clinical anatomy of the popliteal blood vessels","volume":"13","author":"Cross","year":"2000","unstructured":"Cross LHall JHowdieshell TRColborn GLGale TF.Clinical anatomy of the popliteal blood vessels. Clin Anat. 2000;13(5):347-353. doi:10.1002\/1098-2353(2000)13:5<347::Aid-ca4>3.0.Co;2-9"},{"issue":"6","key":"bib22","series-title":"Clin Anat","first-page":"694","article-title":"Anatomical evaluation of the tibial nerve within the popliteal fossa","volume":"20","author":"Driban","year":"2007","unstructured":"Driban JBSwanik CBBarbe MF.Anatomical evaluation of the tibial nerve within the popliteal fossa. Clin Anat. 2007;20(6):694-698. doi:10.1002\/ca.20504"},{"issue":"11","key":"bib23","series-title":"Circ Cardiovasc Interv","first-page":"e007386","article-title":"Transradial artery access complications","volume":"12","author":"Sandoval","year":"2019","unstructured":"Sandoval YBell MRGulati R.Transradial artery access complications. Circ Cardiovasc Interv. 2019;12(11):e007386. doi:10.1161\/circinterventions.119.007386"},{"issue":"2","key":"bib24","series-title":"Ann Vasc Surg","first-page":"260","article-title":"Retrograde transpopliteal access is safe and effective-it should be added to the vascular surgeon's portfolio","volume":"29","author":"Younes","year":"2015","unstructured":"Younes HKEl-Sayed HFDavies MG.Retrograde transpopliteal access is safe and effective-it should be added to the vascular surgeon's portfolio. Ann Vasc Surg. 2015;29(2):260-265. doi:10.1016\/j.avsg.2014.10.013"},{"issue":"2","key":"bib25","series-title":"Neuroradiology","first-page":"279","article-title":"Angiographic challenges of spinal dural and epidural arteriovenous fistulas: report on 45 cases","volume":"66","author":"Takai","year":"2024","unstructured":"Takai KEndo TFujimoto S.Angiographic challenges of spinal dural and epidural arteriovenous fistulas: report on 45 cases. Neuroradiology. 2024;66(2):279-286. doi:10.1007\/s00234-023-03227-5"}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/2\/article-CASE26156.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/2\/article-CASE26156.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/12\/2\/article-CASE26156.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:24Z","timestamp":1784073624000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/12\/2\/article-CASE26156.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,13]]},"references-count":25,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/case26156","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,13]]}}}