title: Intra-arterial indocyanine green angiography in the management of spinal arteriovenous fistulae: technical case reports.
abstract: METHODS
  We first present 2 cases of spinal arteriovenous fistulae (AVFs) successfully treated with the help of intra-arterial indocyanine green (ICG) angiography.
  
  
  OBJECTIVE
  To demonstrate the efficacy of intra-arterial ICG angiography in spinal AVFs compared with the role of intravenous ICG injection and intraoperative digital subtraction angiography (DSA).
  
  
  BACKGROUND
  Intravenous ICG fluorescent angiography is an emerging intraoperative tool to recognize vascular anatomy. The technique is quite simple and provides real-time vascular hemodynamics in the operative field. However, it takes time for the ICG to be washed out; therefore, repeat studies are somewhat tedious and time consuming, especially in spinal AVFs with multiple shunts/drainer. In this setting, intraoperative DSA has still been the standard to confirm the complete obliteration, although this has a risk of radiation exposure and renal failure.
  
  
  METHODS
  Two patients, a 46-year-old man with spinal dural AVF at the cervicomedullary junction and a 68-year-old woman with spinal perimedullary AVF at the conus medullaris, were surgically treated with the help of intra-arterial ICG angiography.
  
  
  RESULTS
  We introduced a catheter into the target artery and injected 0.05 mg ICG in 2 mL of normal saline in multiple, short intervals. This approach enabled us to detect the residual shunt/drainer and confirm complete obliteration. With this technique, a tiny amount of ICG was used in the operative field to clearly label only the affected vessels. Intraoperative DSA was not performed in these cases.
  
  
  CONCLUSIONS
  These cases demonstrate that intra-arterial ICG angiography is a powerful tool for visualizing spinal AVFs in terms of addressing the disadvantages of intravenous ICG injection and intraoperative DSA.
authors: Department of Neurosurgery, Nagasaki University School of Medicine, Sakamoto, Nagasaki, Japan. nobstanford@gmail.com
authors: Nobutaka
authors: N
authors: Horie
authors: Gohei
authors: G
authors: So
authors: Ayumi
authors: A
authors: Debata
authors: Kentaro
authors: K
authors: Hayashi
authors: Minoru
authors: M
authors: Morikawa
authors: Kazuhiko
authors: K
authors: Suyama
authors: Izumi
authors: I
authors: Nagata
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis* / Q000601:surgery; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009192:Myelography / Q000379:methods*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green