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

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  • 1 Department of Neurosurgery, Tokushima University Hospital, Tokushima;
  • 2 Department of Neurosurgery, Shikoku Medical Center for Children and Adults, Zentsuji, Kagawa;
  • 3 Department of Spine, Spinal Cord, Peripheral Nerve Surgery, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa;
  • 4 Department of Neurosurgery, Kitajima Taoka Hospital; and
  • 5 Department of Neurosurgery, Yoshinogawa Hospital, Itano, Tokushima, Japan
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OBJECTIVE

Although 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.

METHODS

Intraarterial 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.

RESULTS

Predissection 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.

CONCLUSIONS

The 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.

ABBREVIATIONS AVF = arteriovenous fistula; AVM = arteriovenous malformation; CCA = common carotid artery; DSA = digital subtraction angiography; ICG = indocyanine green; ROI = region of interest; VA = vertebral artery.

Supplementary Materials

    • Supplemental Table 1 (PDF 389 KB)

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Contributor Notes

Correspondence Kenji Shimada: Tokushima University Hospital, Tokushima, Japan. s_kenji1032@yahoo.co.jp.

INCLUDE WHEN CITING Published online May 22, 2020; DOI: 10.3171/2020.3.JNS20319.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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