title: Evaluation of angiographically occult spinal dural arteriovenous fistulae with surgical microscope-integrated intraoperative near-infrared indocyanine green angiography: report of 3 cases.
abstract: BACKGROUND
  Spinal dural arteriovenous fistulae (dAVFs), are lesions involving an aberrant connection between a radicular feeding artery and the venous system of the spinal cord at the dural sleeve of the nerve root. When rare dAVFs are occult on digitally subtracted catheter-based angiography, they present a diagnostic and therapeutic challenge.
  
  
  OBJECTIVE
  We report 3 cases of angiographically occult spinal dAVFs that were evaluated during surgery with indocyanine green (ICG) fluorescent microscope-integrated angiography.
  
  
  METHODS
  Three patients with clinical and magnetic resonance imaging features suggestive of a spinal dAVF but no abnormality on digital subtraction angiography underwent surgical exploration with the aid of microscope-integrated ICG videoangiography.
  
  
  RESULTS
  In all 3 cases, ICG identified the intradural vein draining the fistula, clearly distinguishing it from an artery or uninvolved medullary vein.
  
  
  CONCLUSIONS
  ICG angiography can rapidly identify a draining vein as it enters the spinal canal even in dAVFs not identifiable on catheter-based digital subtraction angiography.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Brendan D
authors.initials: BD
authors.lastname: Killory
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Peter H
authors.initials: PH
authors.lastname: Maughan
authors.forename: Scott D
authors.initials: SD
authors.lastname: Wait
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000368:Aged; D000792:Angiography / Q000295:instrumentation*; D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007259:Infrared Rays; D008297:Male; D008856:Microscopy, Fluorescence / Q000295:instrumentation; D008866:Microsurgery / Q000295:instrumentation*; D008875:Middle Aged; D009192:Myelography / Q000295:instrumentation*; D013116:Spinal Cord / Q000002:abnormalities / Q000098:blood supply / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*; D018511:Systems Integration; D016896:Treatment Outcome
chemical_list: D007208:Indocyanine Green