The role of indocyanine green video-angiography (ICG-VA) in the surgical resection of vascular malformations has been largely described; conversely, the utility of ICG-VA before dural opening (transdural ICG-VA) in this situation remains unclear. The aim of this study is to present the application of transdural ICG-VA in a consecutive series of patients in order to explore the potential provided by a transdural visualisation of vascular malformations.
We retrospectively analysed the application of intra-operative ICG-VA before dural opening in 15 consecutive patients who underwent surgical resection of vascular malformations. The cases included 12 cerebral arterio-venous malformations (AVMs), 2 cerebral dural arterio-venous fistulas (dAVFs) and 1 spinal arterio-venous fistula (AVF).
ICG-VA before dural opening allowed the visualisation of the site and extension of the malformation in 13 out of 15 cases, whilst arterial feeders and venous drainages were identified in 9 out of 15 cases. In two patients with dAVF, the point of fistula could be transdurally identified through ICG-VA. In 14% of cases, the size of bone flap designed on neuronavigation data was then modified according to transdural ICG-VA findings.
Transdural ICG-VA proved an efficient tool that allows optimising the exposure of the malformation, performing a safe dural opening and identifying dural vascular connections of the lesion.
This is a preview of subscription content, log in to check access.
We’re sorry, something doesn't seem to be working properly.
Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.
Black P (2006) Spinal vascular malformations: an historical perspective. Neurosurg Focus 21(6):E 11
Cognard C, Gobin YP, Pierot L, Bailly AL, Houdart E, Casasco A, Chiras J, Merland JJ (1995) Cerebral dural arteriovenous fistulas: clinical and angiographic correlation with a revised classification of venous drainage. Radiology 194(3):671–680
D’Avella E, Volpin F, Manara R, Scienza R, Della Puppa A (2013) Indocyanine green videoangiography (ICGV)-guided surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS). Acta Neurochir (Wein) 155:415–420
Della Puppa A, Volpin F, Rustemi O, Gioffrè G, Scienza R (2013) Indocyanine green videoangiography (ICGV) in parasagittal meningiomas surgery. considerations on veins management and brain function preservation. Acta Neurochir (Wein) 155(8):1475–6
Della Puppa A, Rustemi O, Gioffrè G, Rolma G, Grandis M, Munari M, Scienza R (2014) Application of indocyanine green video angiography in parasagittal meningioma surgery. Neurosurg Focus 36(2):E13
Hanel RA, Nakaji P, Spetzler RF (2010) Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of spinal dural arteriovenous fistulae. Neurosurgery 66:978–985
Hänggi D, Etminan N, Steiger HJ (2010) The impact of microscope-integrated intraoperative near-infrared indocyanine green videoangiography on surgery of arteriovenous malformations and dural arteriovenous fistulae. Neurosurgery 67:1094–1103
Hettige S, Walsh D (2010) Indocyanine green videoangiography as an aid to surgical treatment of spinal dural arteriovenous fistulae. Acta Neurochir (Wein) 152:533–536
Holling M, Brokinkel B, Ewelt C, Fischer BR, Stummer W (2013) Dynamic ICG fluorescence provides better intraoperative understanding of arteriovenous fistulae. Neurosurgery 73(ONS Suppl 1):ons93–ons99
Jusué-Torres I, Navarro-Ramírez R, Gallego MP, Chaichana KL, Quiñones-Hinojosa A (2013) Indocyanine green for vessel identification and preservation prior to dural opening for parasagittal lesions. Neurosurgery 73(2 Suppl Operative):145
Kato N, Tanaka T, Suzuki Y, Sakamoto H, Arai T, Hasegawa Y, Abe T (2012) Multistage indocyanine green videoangiography for the convexity dural arteriovenous fistula with angiographically occult pial fistula. J Stroke Cerebrovasc Dis 21(8): 918.e1-918.e5
Khurana VG, Seow K, Duke D (2010) Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian neurosurgical experience. Br J Neurosurg 24:163–172
Killory BD, Nakaji P, Gonzales LF, Ponce FA, Wait SD, Spetzler RF (2009) Prospective evaluation of surgical microscope–integrated intraoperative near-infrared indocyanine green angiography during cerebral arteriovenous malformation surgery. Neurosurgery 65:456–462
Killory BD, Nakaji P, Maughan PH, Wait SD, Spetzler RF (2011) Evaluation of angiographically occult spinal dural arteriovenous fistulae with surgical microscope-integrated intraoperative near-infrared indocyanine green angiography: report of 3 cases. Neurosurgery 68(3):781–787
Ng YP, King N, Wan KR, Wang E, Ng I (2013) Uses and limitations of indocyanine green videoangiography for flow analysis in arteriovenous malformation surgery. J Clin Neurosci 20:224–232
Nussbaum ES, Defillo A, Nussbaum L (2012) The use of indocyanine green videoangiography to optimize the dural opening for intracranial parasagittal lesions. Neurosurgery 70 (ONS Suppl 1):ons61–ons64
Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V (2003) Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:132–139
Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, Kamerman JD, Seifert V, Spetzler RF (2005) Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg 103:982–989
Schuette AJ, Cawley CM, Barrow DL (2010) Indocyanine green angiography in the management of dural arteriovenous fistulae. Neurosurgery 67:658–662
Spetzler RF, Martin NA (1986) A proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483
Spetzler RF, Martin NA, Carter P, Flom RA, Raudzens PA, Wilkinson E (1987) Surgical management of large AVM’s by staged embolization and operative excision. J Neurosurg 67:17–28
Takagi Y, Kikuta K, Nozaki K, Sawamura K, Hashimoto N (2007) Detection of a residual nidus by surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography in a child with a cerebral arteriovenous malformation. J Neurosurg 107(Suppl 5):416–418
Ueba T, Abe H, Higashi T, Inoue T (2013) Transdural imaging of meningiomas by indocyanine green videography: the eclipse sign. J Neurol Surg A Cent Eur Neurosurg 74(1):51–53
Ueba T, Okawa M, Abe H, Nonaka M, Iwaasa M, Higashi T, Inoue T, Takano K (2013) Identification of venous sinus, tumor location, and pial supply during meningioma surgery by transdural indocyanine green videography. J Neurosurg 118(3):632–636
Woitzik J, Horn P, Vajkoczy P, Schmiedek P (2005) Intraoperative control of extracranial–intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 102:692–698
Zaidi HA, Abla AA, Nakaji P, Chowdhry SA, Albuquerque FC, Spetzler RF (2014) Indocyanine Green angiography in the surgical management of cerebral arteriovenous malformations: lessons earned in 130 consecutive cases. Neurosurgery 10(Suppl 2):246-251
All authors were equally involved in: the conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published of the paper.
No funding was received for this study.
No ethics committee approval was required for this study, since it was a purely observational work concerning an intraoperative technique That is routinely used in the authors’ institution. Furthermore, informed consent was obtained in all cases from patients, according to the hospital’s ethics guidelines.
Conflicts of interest
This article represents a simple idea to customize transdural approaches for vascular cranial as well as spinal pathologies. Especially for dural arteriovenous fistulas this technique could reach level of surgical standard.
About this article
Cite this article
Della Puppa, A., Rustemi, O., Gioffrè, G. et al. Transdural indocyanine green video-angiography of vascular malformations. Acta Neurochir 156, 1761–1767 (2014). https://doi.org/10.1007/s00701-014-2164-z
- Indocyanine green video-angiography
- Vascular malformation
- Cerebro-vascular surgery