gms | German Medical Science

61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

Intraoperative indocyanine green microscope-integrated videoangiography for obliteration of a recurrent conus arteriovenous malformation – case report and review

Meeting Abstract

  • Aikaterini Patrona - Neurochirurgische Klinik der Ruhr-Universität Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland
  • Sebastian Lücke - Neurochirurgische Klinik der Ruhr-Universität Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland
  • Ramin Naraghi - Neurochirurgische Klinik der Ruhr-Universität Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland
  • Peter Spangenberg - Neurochirurgische Klinik der Ruhr-Universität Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland
  • Albrecht Harders - Neurochirurgische Klinik der Ruhr-Universität Bochum, Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1834

DOI: 10.3205/10dgnc305, URN: urn:nbn:de:0183-10dgnc3055

Published: September 16, 2010

© 2010 Patrona et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Spinal arteriovenous malformations (SAVMs) are a heterogeneous group of vascular anomalies that can render a devastating neurological outcome for the patient if not correctly diagnosed and properly treated. Advancements in non-invasive imaging and optimal use of spinal digital subtraction angiography (DSA) have facilitated accurate diagnosis and choice of treatment. Successful microsurgical treatment is dependent on the neurosurgeon's ability to identify vessels and to confirm the nidus obliteration during surgery. Intraoperative non invasive imaging techniques enhancing this ability are of a tremendous value in reducing procedural risk exposure.

The authors describe the microsurgical occlusion of an intramedullary AVM facilitated by the intraoperative application of indocyanine green (ICG) fluorescent microscope based videoangiography and review the current literature on the use of this technique during surgery of SAVMs. Though there are numerous reports of ICG applications during cerebrovascular procedures, there are few reports about the usage of this technique during surgery of spinal dural arteriovenous fistulas and no described applications in the treatment of intramedullary AVMs.

Methods: The 39-year-old female patient had a history of SAVM of the conus, treated with open surgery twelve years ago. She presented with a new progressive debilitating left side lower-extremity weakness over the last six months. DSA and MR findings revealed an intramedullary AVM at the T-12 level with feeders from the left L1 artery. Unfavourable anatomy precluded endovascular embolization. The patient subsequently underwent surgery. Intraoperative ICG microscope based videoangiography was used as a stand alone imaging technique to identify the arterialized veins and nidus, and to confirm obliteration of the fistulous connection and restoration of normal blood flow.

Results: The ICG applications were fast and uncomplicated and provided real-time information about intra- and perimedullary vascular anatomy and flow with a high spatial resolution that was of important value to intraoperative decision making. The patient’s condition improved rapidly and the postoperative and follow up imaging half a year later confirmed successful obliteration of the AVM.

Conclusions: This case clearly demonstrates the value of intraoperative ICG angiography in the microsurgical treatment of SAVMs, supporting its use as a stand alone technique during surgery of these lesions.