Intraoperative real-time identification of abnormal vessels within the bright field by superselective arterial injection of saline and its slow-motion recording using a high frame rate digital camera during surgical treatment of spinal arteriovenous shunts: technical note

Abstract

<jats:p>The usefulness of superselective arterial injection of indocyanine green (SAI-ICG) during the surgical treatment of a spinal arteriovenous shunts (AVSs) has occasionally been reported. However, SAI-ICG lacks the temporal resolution for recording rapid blood flow. The authors found that SAI of saline (SAIS) via a microcatheter renders the vessels transparent because of the replacement of intravascular blood with saline. By combining SAIS with SAI-ICG, they were able to identify abnormal vessels in the bright field during the surgical treatment of spinal AVS. Furthermore, they performed slow-motion video recording of blood flow in abnormal vessels by mounting a high frame rate (HFR) digital camera on the microscope eyepiece during SAIS. In this paper, the authors present two cases of patients with spinal AVSs. The first patient had a cervical dural arteriovenous fistula, and the second had a thoracic spinal arteriovenous malformation. SAIS delineated abnormal vessels within the bright field in real time in both cases. HFR video was recorded in the second case during SAIS. The slow-motion video showed a smooth and seamless motion of the blood flow in the feeding artery, which facilitated an understanding of the blood flow direction.</jats:p>

Intraoperative Identification of the Shunt Point of Spinal Arteriovenous Malformations by a Selective Arterial Injection of Saline to Subtract Signals of Indocyanine Green: Technical Note

“…The series of procedures were recorded in both the near-infrared and bright field modes. The former represented 3S-ICG, whereas the latter was the same as the selective arterial injection of saline (SAI-S) reported by Hamauchi et al 5…”

“…The intravenous and selective arterial injections of indocyanine green (ICG), and the combination of a high frame rate digital camera and selective arterial injection of saline have been reported to be effective for the intraoperative appreciation of vascular structures, [2][3][4][5] useful in identifying the whole lesion structure, but less helpful in knowing the accurate shunt point.…”

Application of Indocyanine Green During Arteriovenous Malformation Surgery: Evidence, Techniques, and Practical Pearls

“…Although far more research is needed to address the current paucity of published data on the matter, these foundational case series are sparking innovation and unique applications of their own. In a recent study by Hamauchi et al (38), ICG was used in combination with catheterbased intraoperative super-selective spinal angiography and high frame rate videography to help identify abnormal vasculature in a single thoracic intramedullary AVM. The slow-motion replaying of the captured video data was reportedly influential in the surgeons' resection approach, and provided crucial qualitative feedback in real-time to help guide an effective operation.…”