Use of a new indocyanin-green pooling technique for improved visualization of spinal dural AV-fistula: a single center case series.

Use of a new indocyanin-green pooling technique for improved visualization of spinal dural AV-fistula: a single center case series.

World Neurosurg. 2019 Jan 16;:

Authors: Thorsteinsdottir J, Siller S, Dorn F, Briegel J, Tonn JC, Schichor C

Abstract
BACKGROUND: Intra-operative indocyanine green videoangiography (ICG-VAG) is a useful tool in cerebral vascular surgery. In spinal procedures like dural arteriovenous (AV-) fistula, use of ICG-VAG is limited due to lower perfusion pressure. Therefore, we developed a new pooling technique with adapted workflow to improve intraoperative visualization.
METHODS: Patients operated on spinal dAV-fistulas using ICG-VAG were prospectively included. A new workflow for ICG-VAG was applied: 1. Temporary clip placement at suspected fistula point 2. ICG administration during 100% oxygenation 3. ICG pooling proximal of temporary clip 4. Clip removal/ observation of vascular filling. Case records, clinical data, magnetic resonance imaging (MRI), angiography (DSA) and clinical outcome were analysed retrospectively.
RESULTS: 11 patients (median age 68 years, average course of disease 15 months) were included. Optimized, inverted workflow resulted in considerable pooling of ICG in the supplying feeder of the AV-fistula in all cases. Complete obliteration was confirmed in 10 out of 11 patients by post-operative DSA. However, one patient had an additional, preoperative radiologically undetected small feeder which enlarged until postoperative DSA and made successful re-operation necessary. After median follow-up of 33.2 months, Aminoff-Logue-Scale (ALS) was decreased in all patients, McCormick score (modified Rankin score) was improved in 9 (8) patients and remained stable in 2 (3) patients.
CONCLUSIONS: Procedure modification in terms of ICG pooling enabled us to detect more easily the pathological vascular architecture. ICG-VAG is a useful adjunct in surgical treatment of spinal dural AV-fistula since it is a real-time, non-invasive and radiation-free technique with adequate image resolution.

PMID: 30659976 [PubMed - as supplied by publisher]

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