title: Indocyanine green angiography in the surgical management of cerebral arteriovenous malformations: lessons learned in 130 consecutive cases.
abstract: BACKGROUND
  Indocyanine green (ICG) angiography is commonly used to map the vascular configuration of cerebral arteriovenous malformations (AVMs) during resection.
  
  
  OBJECTIVE
  To determine whether ICG improves rates of resection and clinical outcomes.
  
  
  METHODS
  A retrospective chart review was done for all patients undergoing resection of an AVM by the senior author (R.F.S.) between 2007 and 2011. Operative reports, hospital records, and radiographic imaging were used to determine the use of ICG, the incidence of residual disease, and clinical outcomes.
  
  
  RESULTS
  A total of 130 cases (56 ICG, 74 non-ICG) were identified. Average AVM grade (2.2 vs 2.4) and size (2.7 vs 2.7 cm) were similar between the ICG and non-ICG groups, respectively. ICG was more often used when the AVM nidus was close to the cortical surface (71.4% vs 17.6%; P = .001) or lobar (82.1% vs 54.1%; P = .008). Eighteen patients (13.8%) were noted to have residual disease. Reoperation rates and change in modified Rankin Scale score were not different between the 2 groups (12.5% vs 14.9%, P = .8; 0.6 vs 0.4, P = .17). There were no ICG-attributable complications.
  
  
  CONCLUSIONS
  ICG videoangiography is a quick and safe method of intraoperatively mapping the angioarchitecture of superficial AVMs, but it is less helpful for deep-seated lesions. This modality alone does not improve the identification of residual disease or clinical outcomes. Surgeon experience with extensive study of preoperative vascular imaging is paramount to achieving acceptable clinical outcomes. Formal angiography remains the gold standard for the evaluation of AVM obliteration.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Adib A
authors.initials: AA
authors.lastname: Abla
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
authors.forename: Shakeel A
authors.initials: SA
authors.lastname: Chowdhry
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D019781:Corneal Topography; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
chemical_list: D007208:Indocyanine Green