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

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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The role of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intracranial dural arteriovenous fistulas

Journal of Neurosurgery ◽

10.3171/2014.11.jns14947 ◽

2015 ◽

Vol 122 (4) ◽

pp. 876-882 ◽

Cited By ~ 9

Author(s):

Harjot Thind ◽

Douglas A. Hardesty ◽

Joseph M. Zabramski ◽

Robert F. Spetzler ◽

Peter Nakaji

Keyword(s):

Indocyanine Green ◽

Near Infrared ◽

False Negative ◽

False Negative Rate ◽

Indocyanine Green Videoangiography ◽

Surgical Ligation ◽

Arteriovenous Fistulas ◽

Negative Rate ◽

Independent Form ◽

Complete Obliteration

OBJECT The successful treatment of an intracranial dural arteriovenous fistula (dAVF) requires complete obliteration of blood flow through the fistulous point. Surgical ligation is often used along with endovascular techniques. Digital subtraction angiography (DSA) can be used to confirm fistula obliteration; however, this technique can be cumbersome intraoperatively and difficult to correlate anatomically with the surgical field. Near-infrared indocyanine green (ICG) videoangiography has been described as a complementary tool for this purpose. METHODS The authors examined intracranial dAVF cases in which microscope-integrated intraoperative ICG videoangiography was used to identify and/or confirm obliteration of the dAVF during surgery. Retrospective evaluation of all intracranial dAVF cases treated with surgical ligation over a 10-year period at the Barrow Neurological Institute (n = 47) revealed 28 cases in which ICG videoangiography was used. The results were compared with findings on preoperative and intraoperative or postoperative DSA. RESULTS ICG videoangiography successfully confirmed the fistulous point intraoperatively in 96% (22/23) of the cases. It also revealed complete obliteration of fistulas, comparable to intraoperative or postoperative DSA, in 91% (21/23) of the cases. The false-negative rate of ICG was 8.7% (2/23), which is similar to the false-negative rate of intraoperative DSA alone (10.5% [2/19]). CONCLUSIONS Microscope-based ICG videoangiography provides real-time information about the intraoperative anatomy of dAVFs. In addition, it can confirm complete obliteration of a fistula. This technique may be useful during dAVF surgery as an independent form of angiography or as an adjunct to intraoperative or postoperative DSA.

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The Impact of Microscope-Integrated Intraoperative Near-Infrared Indocyanine Green Videoangiography on Surgery of Arteriovenous Malformations and Dural Arteriovenous Fistulae

Neurosurgery ◽

10.1227/neu.0b013e3181eb5049 ◽

2010 ◽

Vol 67 (4) ◽

pp. 1094-1104 ◽

Cited By ~ 69

Author(s):

Daniel Hänggi ◽

Nima Etminan ◽

Hans-Jakob Steiger

Keyword(s):

Indocyanine Green ◽

Arteriovenous Malformations ◽

Near Infrared ◽

Early Passage ◽

Indocyanine Green Videoangiography ◽

Additional Tool ◽

Additional Information ◽

Arteriovenous Fistulas ◽

Venous Phase ◽

The Impact

Abstract BACKGROUND: Microscope-based intraoperative near-infrared indocyanine green (ICG) videoangiography is useful as an adjunct to intra- or postoperative digital subtraction angiography (DSA) in aneurysm surgery. OBJECTIVE: To evaluate intraoperative ICG videoangiography for surgery of arteriovenous malformations (AVMs) and dural arteriovenous fistulas (dAVFs). METHODS: Seventeen patients undergoing surgical resection of intracranial AVM or AVF were enrolled into this prospective evaluation. ICG videoangiography sequences were analyzed with regard to transit times to differentiate between arterial, early venous, capillary, and venous phase as well as early passage (fistula) and delayed appearance (ischemia). ICG videoangiography was compared with pre- and postoperative angiography. RESULTS: Forty-six ICG videoangiographies were performed in 17 operative procedures. In 41 ICG investigations image quality and spatial resolution were excellent to analyze arterial, early venous, capillary, and venous phase. In 2 cases ICG videoangiography provided additional information to change the surgical strategy. With the exception of one case only, the postoperative angiogram corresponded to the last ICG examination performed after the resection. No side effects related to ICG injection were observed. In one patient with a deep thalamic AVM the final ICG investigation was inconclusive owing to insufficient illumination of the deep surgical field. CONCLUSION: Microscope-integrated repetitive ICG videoangiography during AVM and dAVF surgery is fast, easy to perform, and safe. This simple and safe real-time method is a useful additional tool that can potentially lower the surgical risk in complex AVMs and help avoid missed residuals.

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The value of intraoperative angiography in the time of indocyanine green videoangiography in the treatment of cerebrovascular lesions: efficacy, workflow, risk-benefit and cost analysis A prospective study

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106628 ◽

2021 ◽

pp. 106628

Author(s):

Gregor Durner ◽

Hellen Wahler ◽

Michael Braun ◽

Thomas Kapapa ◽

Christian Rainer Wirtz ◽

...

Keyword(s):

Cost Analysis ◽

Indocyanine Green ◽

Prospective Study ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Cerebrovascular Lesions ◽

A Prospective Study

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

World Neurosurgery ◽

10.1016/j.wneu.2019.03.045 ◽

2019 ◽

Vol 126 ◽

pp. 280 ◽

Cited By ~ 1

Author(s):

Francesco Signorelli ◽

Raffaella Messina ◽

Rodolfo Maduri ◽

Giuseppe Barbagallo ◽

Leonello Tacconi

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Indocyanine Green Videoangiography ◽

Pial Arteriovenous Fistula

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Application of Intraoperative Indocyanine Green Videoangiography During Skull Base Surgery—Case Report

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0033-1336323 ◽

2013 ◽

Vol 74 (S 01) ◽

Author(s):

Gustavo A. Cabral ◽

Cristian Nunes ◽

Mario Lapenta ◽

José Landeiro

Keyword(s):

Case Report ◽

Indocyanine Green ◽

Skull Base ◽

Skull Base Surgery ◽

Indocyanine Green Videoangiography

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Evaluation for Perfusion Areas of Bypass Flow by Intraoperative Near-infrared Indocyanine Green Videoangiography in Superficial Temporal Artery-middle Cerebral Artery Bypass Surgery

Surgery for Cerebral Stroke ◽

10.2335/scs.37.233 ◽

2009 ◽

Vol 37 (4) ◽

pp. 233-239 ◽

Cited By ~ 2

Author(s):

Yuji KODAMA ◽

Hideyuki OHNISHI ◽

Katsushi TAOMOTO ◽

Yoshihiro KUGA ◽

Kazuya NAKASHIMA ◽

...

Keyword(s):

Indocyanine Green ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Bypass Surgery ◽

Near Infrared ◽

Artery Bypass ◽

Superficial Temporal Artery ◽

Temporal Artery ◽

Bypass Flow ◽

Indocyanine Green Videoangiography

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Analisis Informasi Citra Anatomi Vaskular dengan Multi Planar Reformating (MPR) dan Maximum Intensity Projection (MIP) pada Fase Early Arteri Pemeriksaan MSCT Abdomen

Jurnal Imejing Diagnostik (JImeD) ◽

10.31983/jimed.v3i2.3192 ◽

2017 ◽

Vol 3 (2) ◽

pp. 240-244

Author(s):

Ratna Istiningrum ◽

Fatimah Fatimah ◽

Tri Wulanhandarini

Keyword(s):

Maximum Intensity Projection ◽

Arterial Phase ◽

P Value ◽

Post Processing ◽

Test Analysis ◽

Vascular Abnormalities ◽

Kappa Test ◽

Anatomical Image ◽

Parametric Statistical Test ◽

Early Arterial Phase

Background: The development in the field of image reconstruction is growing rapidly along with the development of CT Scan. In the early stages of MSCT abdominal artery is usually found various kinds of vascular abnormalities such as stenosis, aneurism and others. Post processing image techniques commonly used include MPR and MIP. The purpose of this study is to determine whether there is a difference between MPR and MIP techniques and to know which one is better between the two.Methods: This research was quantitative study with experimental approach. The study was conducted at Bhakti Dharma Husada Surabaya Hospital with 15 samples by performing reconstruction on vascular anatomical image of coronal examination of abdominal MSCT. Assessment of anatomical information data is done by 2 respondents. Data analysis was done by kappa test followed by Wilcoxon sign rank test.Result : The results showed the difference between the post-processing of MIP and MPR on the coronal stages of the early arterial phase of the abdominal MSCT examination, based on the results of non-parametric statistical test analysis (Wilcoxon) showed a significant value of p value = 0.001. The result of MIP mean rank value (8,46) is higher than the mean rank value of MPR (1,50), it can be known that post proceeding MIP technique on coronal phase cuts early arterial examination of abdominal MSCT produces better anatomical image information.Conclusion: On examination of abdominal MSCT in the early arterial phase should be at the time of processing the image is also done by using post-processing MIP because more clearly than the MPR.

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Advances in Surgical Approaches to Dural Fistulas

Neurosurgery ◽

10.1227/neu.0000000000000228 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S32-S41 ◽

Cited By ~ 19

Author(s):

Patrick P. Youssef ◽

Albert Jess Schuette ◽

C. Michael Cawley ◽

Daniel L. Barrow

Keyword(s):

Treatment Options ◽

Venous Drainage ◽

Venous Hypertension ◽

Surgical Approaches ◽

Dural Sinus ◽

Intraoperative Angiography ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulas ◽

The Past ◽

Dural Arteriovenous Fistulas

Abstract Dural arteriovenous fistulas are abnormal connections of dural arteries to dural veins or venous sinuses originating from within the dural leaflets. They are usually located near or within the wall of a dural venous sinus that is frequently obstructed or stenosed. The dural fistula sac is contained within the dural leaflets, and drainage can be via a dural sinus or retrograde through cortical veins (leptomeningeal drainage). Dural arteriovenous fistulas can occur at any dural sinus but are found most frequently at the cavernous or transverse sinus. Leptomeningeal venous drainage can lead to venous hypertension and intracranial hemorrhage. The various treatment options include transarterial and transvenous embolization, stereotactic radiosurgery, and open surgery. Although many of the advances in dural arteriovenous fistula treatment have occurred in the endovascular arena, open microsurgical advances in the past decade have primarily been in the tools available to the surgeon. Improvements in microsurgical and skull base approaches have allowed surgeons to approach and obliterate fistulas with little or no retraction of the brain. Image-guided systems have also allowed better localization and more efficient approaches. A better understanding of the need to simply obliterate the venous drainage at the site of the fistula has eliminated the riskier resections of the past. Finally, the use of intraoperative angiography or indocyanine green videoangiography confirms the complete disconnection of fistula while the patient is still on the operating room table, preventing reoperation for residual fistulas.

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