Intraoperative indocyanine green angiography for obliteration of a spinal dural arteriovenous fistula

2009 ◽  
Vol 11 (6) ◽  
pp. 705-709 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Alexander L. Coon ◽  
Daniel M. Sciubba ◽  
Ali Bydon ◽  
Philippe Gailloud ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Vascular Anatomy ◽  
Endovascular Embolization ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Spinal Arteriovenous Malformation ◽  
Arteriovenous Fistulas ◽  
Icg Angiography ◽  
Clip Occlusion ◽  
Vascular Neurosurgery

Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 spinal DAVF was diagnosed based on results of conventional spinal angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7–9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG angiography in vascular neurosurgery of the spine.

Spinal Dural Arteriovenous Fistula Presenting with Myelopathy

2019 ◽  
pp. 279-286
Author(s):  
Vinayak Narayan ◽  
Anil Nanda
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Endovascular Embolization ◽  
Spinal Dural Arteriovenous Fistula ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Degenerative Spinal Disease ◽  
Spinal Arteriovenous Malformations ◽  
Spinal Dural Arteriovenous Fistulas

Abstract: Spinal dural arteriovenous fistulas are a rare cause of congestive myelopathy. Symptoms are insidious in onset and may be confused with degenerative spinal disease. MRI characteristically shows edema of the spinal cord with serpiginous flow voids that follow the surface of the spinal cord. Careful evaluation with spinal angiography is required to ensure accurate diagnosis. Spinal dural arteriovenous fistulas differ from spinal arteriovenous malformations in that most fistulas have only a single fistulous point without a nidus. Spinal dural arteriovenous fistulas may be treated successfully with either surgical resection or endovascular embolization depending on their anatomy. Earlier treatment is associated with better outcomes.

PROSPECTIVE EVALUATION OF SURGICAL MICROSCOPE–INTEGRATED INTRAOPERATIVE NEAR-INFRARED INDOCYANINE GREEN ANGIOGRAPHY DURING CEREBRAL ARTERIOVENOUS MALFORMATION SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 456-462 ◽  
Author(s):  
Brendan D. Killory ◽  
Peter Nakaji ◽  
L. Fernando Gonzales ◽  
Francisco A. Ponce ◽  
Scott D. Wait ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Digital Subtraction ◽  
Arteriovenous Shunting ◽  
Icg Angiography ◽  
Normal Vessel ◽  
Vascular Neurosurgery ◽  
Postoperative Findings ◽  
Angiographic Findings

Abstract OBJECTIVE Microscope-integrated indocyanine green (ICG) fluorescence angiography is a novel technique in vascular neurosurgery with potential utility in treating arteriovenous malformations (AVMs). METHODS We analyzed the application of intraoperative ICG in 10 consecutive AVM surgeries for which surgical video was available. The ability to distinguish AVM vessels (draining veins, feeding and nidal arteries) from each other and from normal vessel was evaluated, and ICG angiographic findings were correlated with intra- and postoperative findings on digital subtraction angiography (DSA). RESULTS ICG angiography was found to be useful by the surgeon in 9 of 10 patients. In 8 patients, it helped to distinguish AVM vessels. In 3 of 4 patients undergoing a postresection injection, it demonstrated that there was no residual arteriovenous shunting. In 1 patient, it helped to identify a small AVM nidus that was otherwise inapparent within a hematoma. Intraoperative DSA showed residual AVM in 2 of 10 patients requiring further resection of AVM not visualized during surgery. CONCLUSION Microscope-integrated ICG angiography is a useful tool in AVM surgery. It can be used to distinguish AVM vessels from normal vessels and arteries from veins based on the timing of fluorescence with the dye. Our experience suggests that it is less useful with deep-seated lesions or when AVM vessels are not on the surface. ICG angiography complements rather than replaces DSA.

scholarly journals Influence of indocyanine green angiography on microsurgical treatment of spinal perimedullary arteriovenous fistulas

2016 ◽  
Vol 40 (3) ◽  
pp. E10 ◽  
Author(s):  
Keisuke Takai ◽  
Hiroki Kurita ◽  
Takayuki Hara ◽  
Kensuke Kawai ◽  
Makoto Taniguchi
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Surgical Procedure ◽  
Indocyanine Green Angiography ◽  
Endovascular Embolization ◽  
Surgical Strategy ◽  
Complete Occlusion ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Before And After

OBJECTIVE The microvascular anatomy of spinal perimedullary arteriovenous fistulas (AVFs) is more complicated than that of dural AVFs, and occlusion rates of AVF after open microsurgery or endovascular embolization are lower in patients with perimedullary AVFs (29%–70%) than they are in those with dural AVF (97%–98%). Reports of intraoperative blood flow assessment using indocyanine green (ICG) video angiography in spinal arteriovenous lesions have mostly been for spinal dural AVFs. No detailed reports on spinal perimedullary AVFs are available. METHODS Participants were 11 patients with spinal perimedullary AVFs (Type IVa in 5 patients, Type VIb in 4, and Type IVc in 2). Intraoperative ICG video angiography was assessed by measuring the number of cases in which this modality was judged essential by the surgeon to correctly occlude the fistula. RESULTS In all patients, arterial feeders were identified and intravenous ICG video angiography was performed before and after blocking the feeders. In one patient, selective intraarterial ICG video angiography was also performed. The findings provided by ICG video angiography significantly changed the surgical procedure in 4 of 11 patients (36%). Postoperatively, complete occlusion of the AVF was achieved in 10 of the 11 patients (91%). CONCLUSIONS Intraoperative ICG video angiography can have a significant impact on deciding surgical strategy in the microsurgical treatment of spinal perimedullary AVF.

scholarly journals P.050 Minimally invasive disconnection of spinal dural arteriovenous fistulas in a hybrid neurovascular operating room

2017 ◽  
Vol 44 (S2) ◽  
pp. S26-S26
Author(s):  
SP Lownie ◽  
H Wang ◽  
F Haji ◽  
MR Boulton
Keyword(s):  
Minimally Invasive ◽  
Operating Room ◽  
Spinal Dural Arteriovenous Fistula ◽  
Invasive Approach ◽  
Arteriovenous Fistulas ◽  
3D Angiography ◽  
Image Overlay ◽  
Vascular Neurosurgery ◽  
Spinal Dural Avf ◽  
Spinal Dural Arteriovenous Fistulas

Background: Hybrid neurovascular operating rooms offer significant advantages for vascular neurosurgery. In 2008, we installed North America’s first robotic intraoperative rotational 2D/3D angiography unit in a neurosurgery operating room. To date, 200 procedures have been performed. Methods: In selected cases of spinal dural arteriovenous fistula (dAVF)requiring surgical disconnection, intraoperative spinal angiographic roadmapping, angiographic image overlay onto the skin and surgically exposed spine, and laser cross-hair image guidance were utilized to accurately determine the location and trajectory of the draining vein. Results: In four cases of spinal dAVF, a minimally invasive approach was employed, via either single-level (N=2) or two-level (N=1) hemilaminectomy. Techniques used included: angiographic roadmap / image overlay and intraoperative fluoroscopic with laser light guidance. These provided sub-centimeter accuracy in localizing the path of the draining vein. Surgical incision lengths ranged between 4 to 5 cm, with the shortest incision measuring only 4.2 cm. Complete cure was obtained in all cases, with no untoward complications. Conclusions: Hybrid neurovascular operating room technology can facilitate the use of minimally invasive approaches to spinal dural AVF disconnection.

Clinical and radiographic characteristics of sacral arteriovenous fistulas: a multicenter experience

2021 ◽  
pp. 1-11
Author(s):  
Ricardo A. Domingo ◽  
Gaetano De Biase ◽  
Ramon Navarro ◽  
Jaime L. Martinez Santos ◽  
Gabriella A. Rivas ◽  
...  
Keyword(s):  
Treatment Modality ◽  
Case Reports ◽  
Endovascular Embolization ◽  
Delayed Presentation ◽  
Continuous Variables ◽  
Lower Extremity Weakness ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Small Series ◽  
T2 Hyperintensity

OBJECTIVE Available data on management of sacral arteriovenous fistulas (sAVFs) are limited to individual case reports and small series. Management includes observation, endovascular embolization, or surgical ligation, with no clear guidelines on the optimal treatment modality. The authors’ objective was to report their multiinstitutional experience with management of sAVF patients, including clinical and radiographic characteristics and postprocedural outcomes. METHODS The electronic medical records of patients with a diagnosis of spinal arteriovenous fistula treated from January 2004 to December 2019 at the authors’ institutions were reviewed, and data were summarized using descriptive statistics, including percentage and count for categorical data, median as a measure of central tendency for continuous variables, and interquartile range (IQR) as a measure of dispersion. RESULTS A total of 26 patients with sAVFs were included. The median (IQR) age was 65 (57–73) years, and 73% (n = 19) of patients were male. Lower-extremity weakness was the most common presenting symptom (n = 24 [92%]), and half the patients (n = 13 [50%]) reported bowel and bladder sphincter dysfunction. The median (IQR) time from symptom onset to treatment was 12 (5.25–26.25) months. Radiographically, all patients had T2 hyperintensity at the level of the conus medullaris (CM) (n = 26 [100%]). Intradural flow voids were identified in 85% (n = 22) of patients. The majority of the lesions had a single identifiable arterial feeder (n = 19 [73%]). The fistula was located most commonly at the S1 level (n = 13 [50%]). The site where the draining vein connects to the pial venous plexus was seen predominantly at the lumbar level (n = 16 [62%]). In total, 29 procedures were performed: 10 open surgeries and 19 endovascular embolization procedures. Complete occlusion was achieved in 90% (n = 9) of patients after open surgery and 79% (n = 15) after endovascular embolization. Motor improvement was seen in 68% of patients (n = 15), and bladder and bowel function improved in 9 patients (41%). At last follow-up, 73% (n = 16) of patients had either resolution or improvement of the pretreatment intramedullary T2 signal hyperintensity. CONCLUSIONS T2 hyperintensity of the CM and a dilated filum terminale vein are consistent radiographic signs of sAVF, and delayed presentation is common. Complete occlusion was achieved in almost all patients after surgery, and endovascular embolization was effective in 70% of the patients. Further studies are needed to determine the best treatment modality based on case-specific characteristics.

scholarly journals Dural Arteriovenous Shunt Development in Patients with Vein of Galen Malformation

2014 ◽  
Vol 20 (6) ◽  
pp. 781-790 ◽  
Author(s):  
Srinivasan Paramasivam ◽  
Yasunari Niimi ◽  
Dan Meila ◽  
Alejandro Berenstein
Keyword(s):  
Dura Mater ◽  
Endovascular Embolization ◽  
External Carotid ◽  
Vein Of Galen ◽  
Arteriovenous Fistulas ◽  
Sprouting Angiogenesis ◽  
Multi Stage ◽  
Dural Arteriovenous Shunt ◽  
Age Range

Dural arteriovenous fistulas (DAVF) associated with our series of patients with vein of Galen malformations (VOGM) are analyzed and discussed. We retrospectively analyzed 87 consecutive cases of VOGM treated between May 2002 and December 2011 and identified 26 patients with DAVF. We gathered information from the clinical case records, angiographic images, MRI on presentation and during follow-up. The findings were analyzed to aid discussion. Among 87 patients treated by multi-stage endovascular embolization, age range from newborn to 19 years, 26 (30%) had DAVF. In seven patients (8%), DAVF were found on initial angiogram and were all into the VOGM. Nineteen (21%) DAVF found on follow-up angiograms were all into the VOGM and distant locations. Sprouting and non-sprouting angiogenesis resulted in the formation of a network of vessels around partially thrombosed VOGM, recruiting blood from the surrounding dura mater resulting in a secondary network on the dura mater supplied by the blood vessels of dura mater in the region or from its natural collaterals. Embolization targeting DAVFs was done in 13 (52%) with complete cure in eight (32%) and recurrence in five (20%). Among 12 non-embolized patients (48%), eight (32%) had spontaneous regression with continued treatment of VOGM. In others, the DAVF either remained stable or progressed. DAVF associated with VOGM represent the dural response to angiogenic stimuli. They are observed to regress spontaneously or mature while continuing to treat the primary feeders of VOGM. It is important to include the external carotid system during angiograms. Persistent DAVF with residual VOGM that do not have access though the pial vessels are used as a conduit to treat the dural shunt and to achieve obliteration of residual VOGM at later stages of treatment.

scholarly journals Microsurgery of Spinal Dural Arteriovenous Fistula Using Indocyanine Green Video Angiography: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (1) ◽  
pp. 110-110
Author(s):  
Kunio Yokoyama ◽  
Yasuaki Okuda ◽  
Makoto Yamada ◽  
Hidekazu Tanaka ◽  
Yutaka Ito ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Spinal Dural Arteriovenous Fistula
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