gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Indocyanin-green-videoangiography in spinal dural AV-fistula: a new pooling technique for improved visualization

Meeting Abstract

  • Jun Thorsteinsdottir - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Germany
  • Franziska Dorn - Abteilung für Neuroradiologie, Klinikum der Ludwig-Maximilians-Universität München, Germany
  • Jörg-Christian Tonn - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Germany
  • Christian Schichor - Neurochirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocMO.05.02

doi: 10.3205/16dgnc023, urn:nbn:de:0183-16dgnc0233

Published: June 8, 2016

© 2016 Thorsteinsdottir et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Intra-operative indocyanine green videoangiography (ICG-VAG) is a useful tool in cerebral vascular surgery. In spinal procedures like dural arteriovenous (AV-) fistula, the use of ICG-VAG is limited due to a lower perfusion pressure in the spinal vasculature. Therefore, we developed a new pooling technique with an adapted workflow to improve intraoperative visualization of spinal vascular malformations.

Method: Patients operated on a spinal AV-fistula using ICG-VAG and a microscope-integrated infra-red sensitive monochrome video camera (OPMI Pentero) were prospectively included. We applied a new modification of the established workflow for ICG-VAG. During a period of 100% oxygenation and breathing arrest, ICG was administered intravenously (10mg per dose, Pulsion Medical Systems). Case records, clinical data, pre-/postoperative magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) were analyzed. Clinical outcome was assigned by the modified Aminoff-Logue Scale (ALS), McCormick score and modified Rankin scale (mRS).

Results: Eleven patients (8 male, 3 female) aged 68 years (range: 44-84 years) and an average course of disease of 15 months (range: 2-48 months) were analyzed. Symptoms were basically lower limb numbness, weakness, ataxia and urinary/ defecation dysfunction. Two patients had unsuccessful endovascular therapy before surgery. The optimized, inverted workflow resulted in considerable pooling of fluorescence signal in the supplying feeder of the AV-fistula in all cases. Through this the imaging quality was remarkably improved compared to standard protocols. Complete obliteration was confirmed in eleven patients by post-operative DSA. However, in one patient a remaining small feeder, which was hidden under a fascicle, was not identified during the operation and had to be reoperated. No adverse reactions after ICG administration were seen. After 2.2-16 months of follow-up, ALS was significantly decreased in all patients, McCormick score was improved in 9 patients and remained stable in 2 patients and mRS was decreased in 8 patients and remained stable in 3 patients.

Conclusions: We conclude that ICG-VAG is a useful adjunct in the surgical treatment of spinal dural AV-fistula since it is a simple, real-time, non-invasive, radiation-free technique with good image resolution. Procedure modification in terms of ICG pooling enabled us to detect more easily the pathological vascular architecture in patients harboring spinal AV-fistula.