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  • Intraoperative blood flow evaluation with Indocyanine Green (ICG) Videoangiography for surgical removal of cerebral AVMs: a retrospective analysis on 25 cases.

    Final Number:

    Morgan Broggi MD; Francesco Acerbi MD, PhD; Marco Schiariti; Paolo Ferroli MD; Giovanni Broggi MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: ICG videoangiography (ICGV) has shown to be a useful technique to evaluate the blood flow during different neurovascular and neuro-oncological procedures.

    Methods: A retrospective analysis was conducted on 25 consecutive patients harboring cerebral AVMs operated with the aid of ICGV, from January 2010 to October 2012. All operations were performed using the Pentero microscope with integrated ICG technology (Carl Zeiss, Germany). We used an ICG dosage of 12.5 mg for each injection. Since 2011, Flow 800 software was integrated in the Pentero microscope, to semi-quantitatively evaluate the blood flow in the exposed brain parenchyma. We performed ICGV before (primary superficial survey) and after (terminal assessment) the resection of the AVM. In selected cases, ICGV was used during AVM resection, with clips on main feeders, to evaluate hemodynamic changes and guide AVM resection (progress analysis). The surgical reports, the intraoperative videos and images of each patient were reviewed to analyze the data on intra-operative ICGV (duration, type, and its utility).

    Results: Overall, 53 ICGV (32 Flow 800) during 25 procedures were performed. In 17 out of 21 cases submitted to a primary superficial survey (81%) ICGV was considered useful. ICG Flow 800 was used in 10 of these patients, allowing a simpler understanding of the AVM vessel architecture. A progress analysis was performed with ICG Flow 800 in 6 cases, allowing for a real on-time evaluation of hemodynamic effect of clipping of the main feeders. A terminal assessment was completed in 24 patients. In 21 cases, it confirmed the normalization of arterial and venous flow in the exposed area. In 3 cases the first terminal assessment showed a small portion of unexpected residual nidus or residual A-V, allowing for further AVM removal. DSA or CT-angio confirmed total AVM removal in all cases.

    Conclusions: The result of our retrospective analysis confirmed the utility of ICGV during surgery for AVM.

    Patient Care: Systematic use of ICGV during AVM surgery may provide important information about radical excision of the lesion, thus improving clinical outcome

    Learning Objectives: By the conclusion of this session, participants should be able to: 1. Recognize the importance of blood flow asessment during cerebral AVM surgery. 2. Know when and how to use ICGV for this kind of surgery. 3. Understand ICGV limitations.


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