title: Intraoperative indocyanine green video-angiography as an aid to the microsurgical treatment of spinal vascular malformations.
abstract: AIMS AND OBJECTIVES. Intra-operative Indocyanine Green (ICG) video-angiography (ICG-VA) has become an established aid to cerebrovascular surgery. We describe our experience using this technique to define angio-architecture intraoperatively in a range of spinal vascular malformations. METHODS. A retrospective review of notes and imaging was carried out from a prospectively maintained database. Our series comprises 27 patients who underwent surgical treatment between September 2007 and August 2012. We carried out a retrospective review of data from a prospectively maintained database. RESULTS. For slow-flow Type 1 fistulae the ICG videoangiogram demonstrated conclusively that the arteriovenous shunt was obliterated. This is a consideration on the rare occasions where a second fistula is present, an example of which is included in this series. ICG-VA also helps to demonstrate normal vascular anatomy and distinguish these vessels from pathology. For Type II lesions it allowed orientation to the vascular anatomy as demonstrated by the pre-operative angiogram. In one of two cases in this series it ensured to the complete extirpation of a large arteriovenous malformation (AVM). However a second Type II case demonstrated its limitations, as a diffuse intramedullary component could not be identified. Two cases were explored where digital subtraction spinal angiography was not possible and incomplete understanding of the angio-architectures of the lesions were available from Time Resolved dynamic magnetic resonance angiography and/or multi-detector CT angiography. ICG-VA provided invaluable information on alterations in arterio-venous flow that allowed diagnosis and obliteration of the arteriovenous shunts in each case. DISCUSSION. ICG video-angiography is a time-efficient and safe alternative to intra-operative spinal angiography. It provided useful information on haemodynamic changes intraoperatively and completeness of treatment. We discuss its limitations and role in the management of these lesions.
authors: Department of Neurosurgery, King's College London , Denmark Hill, London , UK.
authors: Daniel C
authors: DC
authors: Walsh
authors: Bassel
authors: B
authors: Zebian
authors: Christos M
authors: CM
authors: Tolias
authors: Richard W
authors: RW
authors: Gullan
mesh_terms: D000792:Angiography / Q000379:methods*; D015901:Angiography, Digital Subtraction; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000601:surgery; D020785:Central Nervous System Vascular Malformations / Q000473:pathology / Q000601:surgery*; D004396:Coloring Agents / Q000008:administration & dosage; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage; D007432:Intraoperative Period; D007796:Laminectomy; D018810:Magnetic Resonance Angiography; D008866:Microsurgery / Q000379:methods*; D038361:Neuronavigation / Q000379:methods; D019635:Neurosurgical Procedures / Q000379:methods*; D013116:Spinal Cord / Q000473:pathology; D014057:Tomography, X-Ray Computed
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green