Usefulness of Repetitive Intraoperative Indocyanine Green-based Videoangiography to Confirm Complete Obliteration of Micro-arteriovenous Malformations

Overview

Journal Surg Neurol Int

Specialty Neurology

Date 2015 May 28

PMID 26015873

Citations 4

Authors

Soichi Oya

Takahide Nejo

Naoaki Fujisawa

Tsukasa Tsuchiya

Masahiro Indo

Takumi Nakamura

Toru Matsui

Affiliations

Soon will be listed here.

Abstract

Background: It is difficult to intraoperatively confirm the total disappearance of arteriovenous (AV) shunts during surgery for microarteriovenous malformations (micro-AVMs), especially when the nidus is extremely small or diffuse on preoperative angiography. Although intraoperative angiography is effective for evaluating residual shunts, procedure-related risks raise important concerns. The purpose of this study was to assess the usefulness of intraoperative indocyanine green-based videoangiography (ICG-VA) to determine complete disappearance of micro-AVMs during surgery.

Methods: We retrospectively analyzed eight patients with ruptured micro-AVMs who were treated using craniotomy with ICG-VA at our institution.

Results: Two patients underwent emergency partial evacuation of hematoma and external decompression before the diagnostic angiography. While three patients had a nidus smaller than 1 cm, five patients had only early draining veins without an appreciable nidus. The draining veins were superficial in six cases and deep in two cases. The average interval from onset to surgery was 33 days (range, 2-57). ICG-VA was repetitively conducted until disappearance of the AV shunt was confirmed. No residual AV shunt was observed on postoperative radiological examinations. In all cases, the diagnosis of AVM was confirmed from the results of postoperative pathological examination.

Conclusions: ICG-VA could detect early draining veins more clearly in situ than diagnostic angiography. Although it is not as effective for visualizing lesions with deep draining veins, repetitive ICG-VA was safe and effective for confirming the disappearance of AV shunts with superficial drainage.

Citing Articles

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References

Zaidi H, Abla A, Nakaji P, Chowdhry S, Albuquerque F, Spetzler R . Indocyanine green angiography in the surgical management of cerebral arteriovenous malformations: lessons learned in 130 consecutive cases. Neurosurgery. 2014; 10 Suppl 2:246-51. DOI: 10.1227/NEU.0000000000000318. View

Faber F, Thon N, Fesl G, Rachinger W, Guckler R, Tonn J . Enhanced analysis of intracerebral arterioveneous malformations by the intraoperative use of analytical indocyanine green videoangiography: technical note. Acta Neurochir (Wien). 2011; 153(11):2181-7. DOI: 10.1007/s00701-011-1141-z. View

Rahal J, Malek A . Benefit of cone-beam computed tomography angiography in acute management of angiographically undetectable ruptured arteriovenous malformations. J Neurosurg. 2013; 119(4):1015-20. DOI: 10.3171/2013.4.JNS1390. View

Margolis G, ODOM G, WOODHALL B, BLOOR B . The role of small angiomatous malformations in the production of intracerebral hematomas. J Neurosurg. 1951; 8(6):564-75. DOI: 10.3171/jns.1951.8.6.0564. View

Andreou A, Ioannidis I, Lalloo S, Nickolaos N, Byrne J . Endovascular treatment of intracranial microarteriovenous malformations. J Neurosurg. 2008; 109(6):1091-7. DOI: 10.3171/JNS.2008.109.12.1091. View

Lobato R, Perez C, Rivas J, Cordobes F . Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg. 1988; 68(4):518-31. DOI: 10.3171/jns.1988.68.4.0518. View

Dehdashti A, Thines L, da Costa L, terBrugge K, Willinsky R, Wallace M . Intraoperative biplanar rotational angiography during neurovascular surgery. Technical note. J Neurosurg. 2009; 111(1):188-92. DOI: 10.3171/2008.12.JNS081018. View

Elhammady M, Heros R . Microarteriovenous malformations. J Neurosurg. 2013; 119(3):591-3. DOI: 10.3171/2012.12.JNS122270. View

Munshi I, Macdonald R, Weir B . Intraoperative angiography of brain arteriovenous malformations. Neurosurgery. 1999; 45(3):491-7; discussion 497-9. DOI: 10.1097/00006123-199909000-00016. View

10.

Hoh B, Carter B, Ogilvy C . Incidence of residual intracranial AVMs after surgical resection and efficacy of immediate surgical re-exploration. Acta Neurochir (Wien). 2004; 146(1):1-7. DOI: 10.1007/s00701-003-0164-5. View

11.

Lane B, Cohen-Gadol A . A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results. Neurosurg Focus. 2014; 36(2):E15. DOI: 10.3171/2013.11.FOCUS13483. View

12.

Stiver S, Ogilvy C . Micro-arteriovenous malformations: significant hemorrhage from small arteriovenous shunts. Neurosurgery. 2000; 46(4):811-8; discussion 818-9. DOI: 10.1097/00006123-200004000-00008. View

13.

Ferroli P, Acerbi F, Broggi M, Broggi G . Arteriovenous micromalformation of the trigeminal root: intraoperative diagnosis with indocyanine green videoangiography: case report. Neurosurgery. 2010; 67(3 Suppl Operative):onsE309-10. DOI: 10.1227/01.NEU.0000381769.15291.4C. View

14.

Ogilvy C, Heros R, Ojemann R, NEW P . Angiographically occult arteriovenous malformations. J Neurosurg. 1988; 69(3):350-5. DOI: 10.3171/jns.1988.69.3.0350. View

15.

Perrini P, Scollato A, Cellerini M, Mangiafico S, Ammannati F, Mennonna P . Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography. Acta Neurochir (Wien). 2004; 146(8):755-66. DOI: 10.1007/s00701-004-0268-6. View

16.

Kono K, Uka A, Mori M, Haga S, Hamada Y, Nagata S . Intra-arterial injection of indocyanine green in cerebral arteriovenous malformation surgery. Turk Neurosurg. 2013; 23(5):676-9. DOI: 10.5137/1019-5149.JTN.6420-12.0. View

17.

Kader A, Young W, Pile-Spellman J, Mast H, Sciacca R, Mohr J . The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. Neurosurgery. 1994; 34(5):801-7; discussion 807-8. DOI: 10.1227/00006123-199405000-00003. View

18.

Wong G, Siu D, Ahuja A, King A, Yu S, Zhu X . Comparisons of DSA and MR angiography with digital subtraction angiography in 151 patients with subacute spontaneous intracerebral hemorrhage. J Clin Neurosci. 2010; 17(5):601-5. DOI: 10.1016/j.jocn.2009.09.022. View

19.

Goren O, Monteith S, Hadani M, Bakon M, Harnof S . Modern intraoperative imaging modalities for the vascular neurosurgeon treating intracerebral hemorrhage. Neurosurg Focus. 2013; 34(5):E2. DOI: 10.3171/2013.2.FOCUS1324. View

20.

Lang S, Beslow L, Bailey R, Vossough A, Ekstrom J, Heuer G . Follow-up imaging to detect recurrence of surgically treated pediatric arteriovenous malformations. J Neurosurg Pediatr. 2012; 9(5):497-504. PMC: 3484378. DOI: 10.3171/2012.1.PEDS11453. View