Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery

Subcortical arteriovenous malformations (AVMs) are surgically challenging. Localization is crucial for eloquent areas, and complete resection evaluation is uncertain. Indocyanine green videoangiography (ICG-VA) can assist this surgery. An illustrative video of a subcortical frontoparietal bleeding AVM resection assisted by ICG-VA is presented. A bleeding arterial feeder aneurysm was embolized in the acute phase to protect against rebleeding. ICG-VA helped to detect the AVM’s superficial arterialized draining vein, distinguishing it from normal cortical veins. This enabled a customized sulcus approach. ICG-VA showed normalized flow through the previously arterialized vein, confirming the AVM’s complete resection. This applies when there is a single drainage remaining.The video can be found here: https://youtu.be/L7yJEE66kV0.

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Efficacy of FLOW 800 with Indocyanine Green Videoangiography for the Quantitative Assessment of Flow Dynamics in Cerebral Arteriovenous Malformation Surgery

World Neurosurgery ◽

10.1016/j.wneu.2014.07.012 ◽

2015 ◽

Vol 83 (2) ◽

pp. 203-210 ◽

Cited By ~ 18

Author(s):

Kenji Fukuda ◽

Hiroharu Kataoka ◽

Norio Nakajima ◽

Jun Masuoka ◽

Tetsu Satow ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Indocyanine Green ◽

Quantitative Assessment ◽

Cerebral Arteriovenous Malformation ◽

Flow Dynamics ◽

Indocyanine Green Videoangiography ◽

Flow 800

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Efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a hybrid operating room

Journal of Neurosurgery ◽

10.3171/2020.3.jns20319 ◽

2020 ◽

pp. 1-9

Author(s):

Kenji Shimada ◽

Tadashi Yamaguchi ◽

Takeshi Miyamoto ◽

Shu Sogabe ◽

Masaaki Korai ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Indocyanine Green ◽

Operating Room ◽

Cerebral Arteriovenous Malformation ◽

Hybrid Operating Room ◽

Indocyanine Green Videoangiography ◽

Flow Reduction ◽

Cerebral Avms ◽

Flow 800 ◽

Short Time

OBJECTIVEAlthough intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs.METHODSIntraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors’ institution is performed in a hybrid operating room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter.RESULTSPredissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings.CONCLUSIONSThe results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.

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