Microsurgical Disconnection of Ruptured Intracranial Pial Arteriovenous Fistula Guided by Indocyanine Green Videoangiography

Abstract BACKGROUND: Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. OBJECTIVE: Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. METHODS: In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. RESULTS: In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. CONCLUSION: IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

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A Case of Cervical Dural Arteriovenous Fistula evaluated by Selective Trans-arterial Indocyanine Green Videoangiography

Japanese Journal of Neurosurgery ◽

10.7887/jcns.27.402 ◽

2018 ◽

Vol 27 (5) ◽

pp. 402-407

Author(s):

Yusuke Funakoshi ◽

Taketo Hatano ◽

Makoto Saka ◽

Mitsushige Ando ◽

Hideo Chihara ◽

...

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Indocyanine Green Videoangiography

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Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.9.peds13683 ◽

2015 ◽

Vol 15 (1) ◽

pp. 55-59 ◽

Cited By ~ 10

Author(s):

Tadashi Sugimoto ◽

Young-Su Park ◽

Ichiro Nakagawa ◽

Fumihiko Nishimura ◽

Yasushi Motoyama ◽

...

Keyword(s):

Indocyanine Green ◽

Arterial Phase ◽

Left Middle Cerebral Artery ◽

Indocyanine Green Videoangiography ◽

Cerebrovascular Lesions ◽

Developmental Problems ◽

Arteriovenous Fistulas ◽

Surgical Options ◽

Pial Arteriovenous Fistula ◽

Early Arterial Phase

Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. The authors report a rare case of pediatric pial AVF treated by direct disconnection with the aid of indocyanine green (ICG) videoangiography. A 3-year-old girl presented with developmental problems. Magnetic resonance imaging revealed brain atrophy and an anomalous left temporal vascular mass. Angiography showed a high-flow pial AVF in the early arterial phase fed by the M1 portion of the left middle cerebral artery and draining into the superficial sylvian vein and the vein of Trolard with a large varix. Given that her fistula was located in a superficial region that was easily accessible by craniotomy, the authors successfully disconnected her pial AVF by direct surgery aided by ICG videoangiography, which clearly confirmed the shunting point. In this report, the authors discuss the existing literature and compare the relative merits of endovascular versus surgical options for the treatment of pial AVF.

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Ruptured Tentorial Arteriovenous Fistula: Endoscopic-Assisted Microsurgical Disconnection Using Indocyanine Green Videoangiography Guidance

World Neurosurgery ◽

10.1016/j.wneu.2019.11.024 ◽

2020 ◽

Vol 134 ◽

pp. 377 ◽

Cited By ~ 2

Author(s):

Raffaella Messina ◽

Maria Teresa Bozzi ◽

Luigi Chiumarulo ◽

Leonello Tacconi ◽

Francesco Signorelli

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Indocyanine Green Videoangiography

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Effectiveness of intraoperative near-infrared indocyanine green videoangiography in a case with recurrent spinal perimedullary arteriovenous fistula

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2010.10.014 ◽

2011 ◽

Vol 113 (3) ◽

pp. 239-242 ◽

Cited By ~ 8

Author(s):

Yasuyuki Miyoshi ◽

Takao Yasuhara ◽

Ayumi Nishida ◽

Koji Tokunaga ◽

Kenji Sugiu ◽

...

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Near Infrared ◽

Indocyanine Green Videoangiography

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Indocyanine Green Videoangiography in Negative: Spinal Dural Arteriovenous Fistula

Global Spine Journal ◽

10.1055/s-0034-1394361 ◽

2014 ◽

Vol 5 (4) ◽

pp. 5-6

Author(s):

Juan Antonio Simal Julián ◽

Pablo Miranda Lloret ◽

Pablo Sanromán Álvarez ◽

Laila Pérez de San Román ◽

Andrés Beltrán Giner ◽

...

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Spinal Dural Arteriovenous Fistula ◽

Indocyanine Green Videoangiography

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Intraoperative Indocyanine Green Videoangiography for Spinal Vascular Lesions: Case Report

Operative Neurosurgery ◽

10.1227/neu.0b013e318207b6b5 ◽

2011 ◽

Vol 68 (suppl_1) ◽

pp. onsE241-onsE245 ◽

Cited By ~ 9

Author(s):

Tomohiro Murakami ◽

Izumi Koyanagi ◽

Takahisa Kaneko ◽

Satoshi Iihoshi ◽

Kiyohiro Houkin

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Digital Subtraction Angiography ◽

Near Infrared ◽

Vascular Lesions ◽

Vascular Tumors ◽

Digital Subtraction ◽

Indocyanine Green Videoangiography ◽

Surgical Microscope ◽

Spinal Arteriovenous Fistula

Abstract BACKGROUND AND IMPORTANCE: In surgery of spinal vascular lesions such as spinal arteriovenous fistula or vascular tumors, assessment of feeding arteries and draining veins is important. Intraoperative digital subtraction angiography is useful but is invasive and sometimes technically demanding. Near-infrared indocyanine green (ICG) videoangiography is less invasive and has been reported as an intraoperative diagnosis of arterial patency during clipping surgery of cerebral aneurysms or bypass surgeries. We present our experience with intraoperative ICG videoangiography in 3 cases of spinal vascular lesions. CLINICAL PRESENTATION: Two patients had spinal arteriovenous fistula (perimedullary, n = 1; dural, n = 1), and 1 patient had spinal cord hemangioblastoma at the thoracic or thoracolumbar level. The surgical microscope was an OPMI Pentero (Carl Zeiss, Oberkochen, Germany). After laminectomy and opening of the dura, ICG (5 mg) was injected intravenously. The ICG angiography clearly demonstrated feeding and draining vessels. The ICG findings greatly helped successful interruption of arteriovenous fistula and total removal of the tumor. CONCLUSION: Intraoperative ICG videoangiography for spinal vascular lesions was useful by providing information on vascular dynamics directly. However, the diagnostic area is limited to the field of the surgical microscope. Although intraoperative digital subtraction angiography is still needed in cases of complex spinal vascular lesions, ICG videoangiography will be an important diagnostic modality in the field of spinal vascular surgeries.

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Application of the selective indocyanine green videoangiography in microsurgical treatment of a craniocervical junction dural arteriovenous fistula

Neurosurgical FOCUS ◽

10.3171/2019.2.focusvid.18681 ◽

2019 ◽

Vol 46 (Suppl_2) ◽

pp. V5 ◽

Cited By ~ 1

Author(s):

Liyong Sun ◽

Jian Ren ◽

Hongqi Zhang

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Operative Technique ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Indocyanine Green Videoangiography ◽

Unique Type ◽

Midline Approach ◽

Neurovascular Anatomy ◽

Fistula Site

Craniocervical junction dural arteriovenous fistula (CCJDAVF) is a rare and unique type of intracranial DAVF with complex neurovascular anatomy, making it difficult to identify the arterialized vein during operation. The authors report the case of a 50-year-old male who presented with symptoms of venous hypertensive myelopathy. Angiography demonstrated a left CCJDAVF. The fistula was successfully disconnected via a suboccipital midline approach. The selective indocyanine green videoangiography (SICG-VA) technique was applied to distinguish the fistula site and arterialized vein from adjacent normal vessels. Favorable clinical and angiographic outcomes were attained. The detailed operative technique, surgical nuances, and utility of SICG-VA are illustrated in this video atlas.The video can be found here: https://youtu.be/GJYl_jOJQqU.

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