Transdural indocyanine green video-angiography of vascular malformations

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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.

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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


Author information

Correspondence to Alessandro Della Puppa.

Additional information


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.

Daniel Hänggi

Duesseldorf, Germany

Electronic supplementary material

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Illustrative video of transdural ICG-VA of patient 5 (Fig. 1) (MPG 1952 kb)

Video 1

Illustrative video of transdural ICG-VA of patient 5 (Fig. 1) (MPG 1952 kb)

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Della Puppa, A., Rustemi, O., Gioffrè, G. et al. Transdural indocyanine green video-angiography of vascular malformations. Acta Neurochir 156, 1761–1767 (2014).

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  • Indocyanine green video-angiography
  • ICG-VA
  • AVM
  • dAVF
  • Vascular malformation
  • Cerebro-vascular surgery