title: The role of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intracranial dural arteriovenous fistulas.
abstract: OBJECTIVE
  The successful treatment of an intracranial dural arteriovenous fistula (dAVF) requires complete obliteration of blood flow through the fistulous point. Surgical ligation is often used along with endovascular techniques. Digital subtraction angiography (DSA) can be used to confirm fistula obliteration; however, this technique can be cumbersome intraoperatively and difficult to correlate anatomically with the surgical field. Near-infrared indocyanine green (ICG) videoangiography has been described as a complementary tool for this purpose.
  
  
  METHODS
  The authors examined intracranial dAVF cases in which microscope-integrated intraoperative ICG videoangiography was used to identify and/or confirm obliteration of the dAVF during surgery. Retrospective evaluation of all intracranial dAVF cases treated with surgical ligation over a 10-year period at the Barrow Neurological Institute (n = 47) revealed 28 cases in which ICG videoangiography was used. The results were compared with findings on preoperative and intraoperative or postoperative DSA.
  
  
  RESULTS
  ICG videoangiography successfully confirmed the fistulous point intraoperatively in 96% (22/23) of the cases. It also revealed complete obliteration of fistulas, comparable to intraoperative or postoperative DSA, in 91% (21/23) of the cases. The false-negative rate of ICG was 8.7% (2/23), which is similar to the false-negative rate of intraoperative DSA alone (10.5% [2/19]).
  
  
  CONCLUSIONS
  Microscope-based ICG videoangiography provides real-time information about the intraoperative anatomy of dAVFs. In addition, it can confirm complete obliteration of a fistula. This technique may be useful during dAVF surgery as an independent form of angiography or as an adjunct to intraoperative or postoperative DSA.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Harjot
authors.initials: H
authors.lastname: Thind
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Hardesty
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D020785:Central Nervous System Vascular Malformations / Q000473:pathology* / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004396:Coloring Agents; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D007223:Infant; D007259:Infrared Rays; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000209:etiology / Q000601:surgery; D009460:Neurologic Examination; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: DSA = digital subtraction angiography; ICG = near-infrared indocyanine green; dAVF = dural arteriovenous fistula; indocyanine green videoangiography; intracranial dural arteriovenous fistula; intraoperative imaging techniques; vascular disorders