Use of Fluorescent Indocyanine Green Angiography During Microsurgical Resection of a Recurrent Giant Perimedullary Cervical Spinal Arteriovenous Fistula in a Patient with Hereditary Hemorrhagic Telangiectasia: A Case Report

Abstract

We report the utility of fluorescent indocyanine green (ICG) during the microsurgical resection of a giant perimedullary cervical arteriovenous fistula (GPMAVF) in a young man with hereditary hemorrhagic telangiectasia. ICG angiography is a useful adjunct for understanding angioarchitecture and drainage patterns in spinal arteriovenous malformation (AVM) surgery. Cervical GPMAVF is a rare spinal lesion found in association with hereditary hemorrhagic telangiectasia. This vascular malformation is associated with venous varices in a perimedullary location causing cord compression and vascular steal. This rare case highlights the crucial role of ICG during complex spinal AVM/AVF surgery to obtain angiographic cure.

The Role of Minimally Invasive Spinal Surgical Procedures in the Elderly Patient: An Analysis of 49 Patients Between 75 and 95 Years of Age

“…In healthy patients, this allows them to continue their lifestyle while patients regarded to be at very high risk for more complicated spinal procedures and especially general anesthesia can get pain relief, improvement in activity and quality of life due to relief of neurogenic claudication very similar to more complicated procedures such as decompression and fusions with or without screw fixation [21][22][23]. The most common spinal problems that are seen in the elderly population and in which minimally invasive spinal procedures are applicable include vertebral compression fractures with acute incapacitating or later chronic back pain, spinal stenosis with neurogenic claudication, acute far lateral discs that are often seen in the upper lumbar spine, and chronic pain secondary to failed laminectomy, degenerative scoliosis, and spondylosis often in combination with diabetic or vascular neuropathy [23][24]. As the spinal surgeon, interventional pain management specialist or even interventional radiologists and especially anesthesia team become comfortable with performing procedures under local anesthesia, and as the operative time of the experienced surgeon becomes shorter, it is possible to recommend minimal invasive procedures when supported by diagnostic studies with faster return home, ambulation, post-procedure physical therapy, and less morbidity with similar outcomes [25][26].…”

Spinal Dural Arteriovenous Fistulas Supplied from Multiple Segmental Arteries: Microsurgery Using Indocyanine Green Angiography and Radiosurgery with a Spine Tracking System

“…The recently developed indocyanine green (ICG) angiography technique is very useful for detecting feeding arteries or draining veins at different levels [9]. The intra-arterial administration of ICG has also been reported to have benefits with respect to the use of multiple and short interval injections versus intravenous administration, although it is necessary to place a catheter into the target artery prior to surgery [10].…”