Leveraging machine learning with real-world data for hypothesis generation by identifying exposomic predictors in Parkinson's disease among farmers.

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular malformation account for approximately 70%–80% (), it is still rare, and the etiology of which is not entirely clear. Epidemiological investigations have shown that the incidence of SDAVF is 5–10 per million per year (). The major clinical manifestations of SDAVF include motor, sensory, and sexual dysfunction with significant neurological consequences if left untreated (, ). Misdiagnosis as a spinal degenerative disorder is common due to its non-specific clinical features (), a study conducted in 2019 found that 78% SDAVFs were misdiagnosed, and leading to irreversible neurological dysfunction (). Treatment options include endovascular embolization and operation include microsurgery, and the choice remains somewhat controversial. In the present two cases, surgical treatment was preferred over endovascular embolization for the following reasons: (1) the fistulas were single-level lesions readily accessible via a minimally invasive posterior approach, (2) the angioarchitecture on preoperative DSA did not demonstrate anatomical features that would preclude safe surgical obliteration, and (3) surgical ligation offers the advantages of direct visualization, immediate confirmation of fistula obliteration via intraoperative ICG angiography, and a well-documented favorable long-term occlusion rate (). We recently performed SDAVF surgery in two patients using a modified microtubular approach and report our experience here. A literature review was conducted to identify published cases of SDAVF treated with minimally invasive surgical approaches. The PubMed, Embase, and Web of Science databases were searched from inception to May 2025 using the following keywords: “spinal dural arteriovenous fistula,” “SDAVF,” “surgery,” “microsurgery,” “minimally invasive,” “tubular retractor,” “micro-tubular,” and “microchannel.” Studies were included if they described minimally invasive surgical techniques for the treatment of SDAVF. After removing duplicates and screening, three studies reporting minimally invasive surgical approaches for SDAVF were identified (), together with the two cases presented in this report. Summary of reported cases of SDAVF treated with minimally invasive surgery.