Introduction: The successful treatment of an intracranial dural ateriovenous 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 utilized for confirmation of 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: We examined intracranial dAVF cases in which microscope-integrated intraoperative ICG videoangiography was used to identify and/or confirm obliteration of the dAVF at surgery. Retrospective evaluation of all intracranial dAVF cases treated with surgical ligation over a 10-year period identified 28 cases in which ICG videoangiography was used. These results were compared with findings on preoperative and intra- or postoperative DSA.
Results: ICG videoangiography successfully confirmed the identity of the fistula point intraoperatively in 96% of cases as compared to preoperative angiography. ICG videoangiography also demonstrated complete obliteration of fistulas as well as intra- or postoperative DSA in 91% of cases. Good clinical outcomes were obtained in 75% of cases.
Conclusions: Microscope-based ICG videoangiography provides real-time information about the intraoperative anatomy of dAVFs. In addition, it can confirm complete obliteration of the fistula. This technique may be useful during dAVF surgery as an independent form of angiography or as an adjunct to intra- or postoperative DSA.
Patient Care: By propagating the routine use of ICG angiography (a safe, quick, and inexpensive technique) for use in the treatment of cranial dAVFs
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of ..ICG angiography in the surgery of cranial dAVF, 2) Discuss, in small groups, strategies for the use of ICG angiography 3) Identify an effective treatment for patients with cranial dAVF using ICG angiography