Efficacy of intraarterial superselective indocyanine green videoangiography in cerebral arteriovenous malformation surgery in a hybrid operating room

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Although intravenous indocyanine green (ICG) videoangiography has been reported to be useful when applied to cerebral arteriovenous malformation (AVM) surgery, the ICG that remains after the procedure makes it difficult to understand the anatomy, to evaluate nidus blood flow changes, and to repeat ICG videoangiography within a short time. Intraarterial ICG videoangiography has emerged as a way to overcome these limitations. The current study presents the results of intraarterial ICG videoangiography undertaken in patients with cerebral AVMs.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Intraarterial ICG videoangiography was performed in 13 patients with cerebral AVMs. Routine intraoperative digital subtraction angiography at the authors’ institution is performed in a hybrid operating room during AVM surgery and includes the added step of injecting ICG to the contrast medium that is administered through a catheter.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Predissection studies were able to visualize the feeder in 12 of 13 cases. The nidus was visualized in 12 of 13 cases, while the drainer was visualized in all cases. After total dissection of the nidus, there was no ICG filling in the drainers found in any of the cases. Washout of the ICG took 4.4 ± 1.3 seconds in the feeders, 9.2 ± 3.5 seconds in the drainers, and 20.9 ± 3.4 seconds in all of the vessels. Nidus flow reduction was confirmed during dissection in 9 of 9 cases. Flow reduction was easy to recognize due to each span being very short. Color-encoded visualization and objective data obtained by Flow 800 analysis reinforced these findings.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>The results showed that intraarterial ICG videoangiography was more useful than intravenous ICG videoangiography in cerebral AVM surgery. This was especially effective in the identification of the feeder, nidus, and drainer and in the assessment of the flow dynamics of the nidus. Use of Flow 800 made it simpler and easier to evaluate these findings.</jats:p></jats:sec>

Efficacy of intraarterial indocyanine green videoangiography in surgery for arteriovenous fistula at the craniocervical junction in a hybrid operating room: illustrative cases

“…We have not encountered any adverse coagulation events in our institute, thanks to the implementation of countermeasures involving mandatory connection of all catheters to a pressurized heparinized saline bag for the purpose of flushing, with catheter irrigation performed every 15 minutes. 4 , 5 …”

“…Further, the method is easily repeated due to the short ICG washout time, unlike intravenous ICG videoangiography. 4 , 5 Here, we present two cases of CCJ AVFs in which intraarterial ICG videoangiography proved useful for accurate diagnosis and successful treatment. Intraarterial ICG videoangiography was approved by the ethics review board at Tokushima University.…”

“… 2 , 3 We previously reported the usefulness of intraarterial ICG videoangiography for arteriovenous malformation and hemangioblastoma surgery. 4 , 5 This technique helps surgeons understand the angioarchitecture of vascular malformation more easily than with intravenous ICG videoangiography because of brighter and higher phase contrast. Further, the method is easily repeated due to the short ICG washout time, unlike intravenous ICG videoangiography.…”

Evaluation of Serial Intra-Arterial Indocyanine Green Videoangiography in the Surgical Treatment of Cranial and Craniocervical Junction Arteriovenous Fistulae: A Case Series

“…To avoid thromboembolic complications, pressurized (280 mm Hg) 500-mL bags of heparinized saline (4 U/mL) were connected to all catheters for the purpose of continuous flushing, with manual catheter irrigation performed every 15 minutes. 14 Routine intraoperative DSA studies were primarily performed before and after operative disconnection of the fistulae.…”

Efficacy of Intra-arterial Indocyanine Green Videoangiography in Hemangioblastoma Surgery: A Case Report

“…A few recent studies have examined intra-arterial injection of ICG, describing its usefulness for cerebral aneurysms and AVMs by overcoming the technical limitations of intravenous ICG videoangiography. 13 – 15) Here, we provide the first description of hemangioblastoma treated successfully using intra-arterial ICG videoangiography during surgery in a hybrid operating room and the efficacy of this technique.…”