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BACKGROUND: With the use of indocyanine green (ICG) as a novel fluorescent dye, fluorescence angiography has recently re-emerged as a viable option.
OBJECTIVE: To show the result of ICG videoangiography in cases of cerebral arteriovenous malformations.
METHODS: Twenty-seven ICG videoangiography procedures were performed in eleven patients with cerebral arteriovenous malformations. Intraoperative digital subtraction angiography (DSA) was performed twenty-seven times in these patients. The timing of intraoperative DSA was pre-dissection, post-clipping of feeders and after- dissection of the nidus.
RESULTS: The procedures were performed in 4.7+1.4 minutes, (mean+SD, n=27), whereas intraoperative digital subtraction angiography was performed for a mean of 16.6+3.8 minutes (mean+SD, n=27). In pre-dissection studies, feeders were visualized by ICG in three of nine cases. The nidus was visualized in all nine cases and drainers were visualized in eight. Intraoperative DSA visualized the feeders, nidus and drainers in all nine cases. After clipping of feeders, ICG videoangiography showed flow reduction of the nidus in seven of seven cases. Intraoperative DSA also showed that in nine of nine cases. After total dissection of the nidus, all cases disclosed that the drainers were without ICG filling. Intraoperative DSA also showed that in all of the cases. Unexpected residual nidus was not visualized in our series using either method.
CONCLUSION: ICG videoangiography is helpful for resecting cerebral AVM. It is especially effective in visualizing the nidus and superficial drainers, as well as changes in flow after clipping or coagulating of feeders.
Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.
Júlio Leonardo B. Pereira
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