gms | German Medical Science

Objective: Microscope-based intraoperative near-infrared indocyanine green (ICG) videoangiography was shown to be useful and as an adjunct to intra- or postoperative digital subtraction angiography (DSA) in aneurysm surgery. The goal of the present study was to evaluate intraoperative ICG videoangiography in arteriovenous malformation (AVM) and dural arteriovenous fistula (dAVF) surgery.

Methods: Patients with AVM evaluated for surgical treatment were enhanced to the study prospectively. The ICG technique was performed microscope-integrated (Carl Zeiss Co., Oberkochen, Germany). ICG videoangiography sequences were analyzed time related to differentiate between arterial, early venous, capillary and venous filling. Furthermore the ICG videoangiography was compared with the pre- and postoperative angiography.

Results: 29 ICG videoangiographies were performed in 12 patients in 12 operative procedures. In 28 ICG investigations the image quality and spatial resolution was excellent to analyze the arterial, early-venous, capillary and venous phases. As a result a real-time evaluation of the angioarchitecture of parts or the complete vascular pathology was possible and comparable with images of DS angiographies. In two cases the ICG videoangiography provided information to change the surgical procedure. In all cases, the postoperative angiogram corresponds to the ICG examination performed to control the resection quality. At last, no side effects were observed after the injections of ICG. In one patient with a deep thalamic AVM the final ICG investigation was not conclusive due to probably the depth of the surgical field.

Conclusions: Microscope-integrated ICG videoangiography in AVM and dAVF surgery provides useful information about intraoperative configuration and residual nidus detection. This simple and safe real-time feedback could be considered as a useful additional tool for the surgeon.