gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

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Multistage intraoperative indocyanine green videoangiography for the convexity dural arteriovenous fistula associated with angiographically occult pial fistula

Meeting Abstract

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  • N. Kato - Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba
  • T. Tanaka - Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba
  • H. Sakamoto - Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba
  • T. Arai - Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba
  • Y. Hasegawa - Department of Neurosurgery, Jikei University School of Medicine Kashiwa Hospital, Kashiwa, Chiba
  • T. Abe - Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.15.01

doi: 10.3205/12dgnc133, urn:nbn:de:0183-12dgnc1332

Published: June 4, 2012

© 2012 Kato 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

Text

Objective: To evaluate the usefulness of multistage intraoperative indocyanine green (ICG) videoangiogrpahy during surgical procedure for intracranial dural arteriovenous fistula (AVF).

Methods: The method was applied for a patient with the left convexity parasagittal dural AVF. A 41-year-old man suffering from right hemiplegia caused by left subcortical hemorrhage due to the dural AVF.

Results: He underwent surgical resection of the dural AVF. In this operation we performed step-by-step ICG videoangiography 4 times in each dissection procedure of the fistula, which provided us precise structure of the dural AVF. After circular incision of the dura around the fistular point, repeated ICG videoangiography indicated the residual fistula between the pial artery from the middle cerebral artery (MCA) and the draining vein. Complete disappearance of the AVF was confirmed by ICG videoangiography after removing this pial fistula. Postoperative DSA also revealed no residual AVF.

Conclusions: Accurate detection of all fistular points and complete resection including the dura mater and pial vessels are necessary to avoid rebleeding caused by the residual AVF due to incomplete obliteration of the fistular points. The intraoperative ICG videoangiography could provide information of angiographically occult vascular malformation such as the pial fistulas that could not be detected by preoperative DSA. These findings suggest that multistage intraoperative ICG videoangiography would be quite useful for complete resection of the dural AVF with angiographically occult pial fistula.