title: Evaluation of serial intraoperative surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography in patients with cerebral arteriovenous malformations.
abstract: BACKGROUND
  With the use of indocyanine green (ICG) as a novel fluorescent dye, fluorescence angiography has recently reemerged 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 11 patients with cerebral arteriovenous malformations. Intraoperative digital subtraction angiography (DSA) was performed 27 times in these patients. The timing of intraoperative DSA was before dissection, after clipping of feeders, and after dissection of the nidus.
  
  
  RESULTS
  The procedures were performed in 4.7 ± 1.4 minutes (mean ± SD; n = 27 minutes), whereas intraoperative digital subtraction angiography was performed for a mean of 16.6 ± 3.8 minutes (n = 27 minutes). In predissection studies, feeders were visualized by ICG in 3 of 9 cases. The nidus was visualized in all 9 cases, and drainers were visualized in 8. Intraoperative DSA visualized the feeders, nidus, and drainers in all 9 cases. After clipping of feeders, ICG videoangiography showed flow reduction of the nidus in 7 of 7 cases. Intraoperative DSA also showed that finding in 9 of 9 cases. After total dissection of the nidus, all cases disclosed that the drainers were without ICG filling. Intraoperative DSA also showed that result in all of the cases. Unexpected residual nidus was not visualized in our series with either method.
  
  
  CONCLUSIONS
  We found that ICG videoangiography is helpful for resecting cerebral arteriovenous malformation. It is especially effective in visualizing the nidus and superficial drainers, as well as changes in flow after clipping or coagulating of feeders.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. ytakagi@kuhp.kyoto-u.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Keiko
authors.initials: K
authors.lastname: Sawamura
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods*; D002675:Child, Preschool; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods*; D011300:Preoperative Care / Q000379:methods; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D016896:Treatment Outcome; D014741:Video Recording / Q000379:methods; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green