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

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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Indocyanine Green Videoangiography “In Negative”: Definition and Usefulness in Intracranial Dural Arteriovenous Fistulae

Operative Neurosurgery ◽

10.1227/neu.0b013e318282ddd6 ◽

2013 ◽

Vol 73 (suppl_1) ◽

pp. ons86-ons92 ◽

Cited By ~ 1

Author(s):

Juan Antonio Julián ◽

Pablo Miranda Lloret ◽

Fernando Aparici Robles ◽

Andrés Beltrán Giner ◽

Carlos Botella Asunción

Keyword(s):

Indocyanine Green ◽

Arteriovenous Fistula ◽

Arteriovenous Malformations ◽

Dural Arteriovenous Fistula ◽

Simple Procedure ◽

Vascular Pathology ◽

Digital Subtraction ◽

Indocyanine Green Videoangiography ◽

Arteriovenous Fistulae ◽

Intracranial Dural Arteriovenous Fistulae

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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Craniocervical Junction Vertebral Artery Dural Arteriovenous Fistula With Cranial and Spinal Venous Reflux: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz213 ◽

2019 ◽

Vol 18 (5) ◽

pp. E162-E163 ◽

Cited By ~ 1

Author(s):

Krunal Patel ◽

Leonardo Desessards Olijnyk ◽

Anderson Chun On Tsang ◽

Vitor Mendes Pereira ◽

Ivan Radovanovic

Keyword(s):

Vertebral Artery ◽

Arteriovenous Fistula ◽

Dural Arteriovenous Fistula ◽

Craniocervical Junction ◽

Lateral Approach ◽

Venous Reflux ◽

Suboccipital Craniotomy ◽

Far Lateral Approach ◽

Key Steps ◽

Midline Approach

Abstract Dural arteriovenous fistulae at the craniocervical junction are rare. When present together with spinal and cranial venous reflux they can have an aggressive natural history with hemorrhage or progressive myelopathy from venous congestion. In this operative video we demonstrate key steps in the surgical ligation of a dural arteriovenous fistula supplied by meningeal branches of the V4 segment of the vertebral artery. Informed consent was obtained. The patient was positioned prone with chin tucked. Utilizing a midline suboccipital craniotomy and removal of the arch of C1, the vertebral artery was identified at its V4 segment at it transitions from extra to intradural. The video illustrates how a midline approach can be used to access this lesion and a far lateral approach is not required to access the vertebral artery and its dural branches at the craniocervical junction. Division of the denticulate ligaments and mobilization of the spinal accessory nerve allows visualization of the proximal portion of the draining vein. Important anatomy in this region is demonstrated. The critical use of indocyanine green (ICG) dye is demonstrated as the first 2 clip applications were not proximal enough to obliterate the proximal draining vein and persistent early venous reflux was still seen on ICG. The importance of access to and obliteration of the proximal draining vein is shown. An intraoperative ICG and postoperative angiogram demonstrates complete occlusion of the dural arteriovenous fistula. In this case the patient had minor sensory deficits postoperatively which were resolved by 6 wk postoperatively.

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