Introduction The spatial understanding of spinal vascular malformations is traditionally based on high-resolution 2D DSA. 3D CBCT has the potential to further elucidate the pathophysiological anatomy of spinal vascular malformations, which is a prerequisite for targeted interventional or surgical therapy.

Aim of Study To investigate the added diagnostic value of 3D CBCT in spinal vascular malformations.

Methods Between 2019 and 2024, 10 patients with spinal vascular malformations underwent 3D CBCT as part of spinal DSA. CBCT findings were correlated with high-resolution intraoperative microscopic images including ICG video angiography.

Results Nine patients with spinal dAVFs and 1 patient with spinal AVM were investigated. In all patients, CBCT led to a more comprehensive understanding of the lesion anatomy and its relationship to the healthy vascular system. The studies were correlated with intraoperative findings in 9/10 patients (pending treatment in 1 patient). Successfull occlusion of the lesions was confirmedin 8/9 patients (1 lost on F/U).

Conclusion The use of CBCT in spinal vascular malformations yields new insights into normal and pathologic anatomy. It provides superior visualization of the fistula and its relationship with spinal cord vessels, which is a prerequisite for targeted endovascular or surgical treatment.

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Abstract P086 Figure 1

Exemplary Case: Spinal dural arteriovenous fistula in 69-year-old female, a fistula point was preoperatively visualized at the Th7 level with dominant arterial supply via the left Th7 segmental artery. Collaterals to the fistula from the left Th6 segmental artery were visualized as well as an outlet of the left Th6 radiculomedullary artery. Corresponding intraoperative imagine confirmed thefistula point at Th7 level and showed immediate collapse of the draining perimedullary vein after closure of the fistula

Disclosure of Interest yes Educational & Travel Grants: Stryker, Balt, Medtronic.