Skip to main content

Advertisement

SpringerLink
Log in

Enhanced analysis of intracerebral arterioveneous malformations by the intraoperative use of analytical indocyanine green videoangiography: technical note

  • Technical Note
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

In cerebral arterioveneous malformations (AVMs) detailed intraoperative identification of feeding arteries, nidal vessels and draining veins is crucial for surgery. Intraoperative imaging techniques like indocyanine green videoangiography (ICG-VAG) provide information about vessel architecture and patency, but do not allow time-dependent analysis of intravascular blood flow. Here we report on our first experiences with analytical indocyanine green videoangiography (aICG-VAG) using FLOW 800 software as a useful tool for assessing the time-dependent intraoperative blood flow during surgical removal of cerebral AVMs. Microsope-integrated colour-encoded aICG-VAG was used for the surgical treatment of a 38-year-old woman diagnosed with an incidental AVM, Spetzler Martin grade I, of the left frontal lobe and of a 26-year-old man suffering from seizures caused by a symptomatic AVM, Spetzler Martin grade III, of the right temporal lobe. Analytical ICG-VAG visualization was intraoperatively correlated with in situ micro-Doppler investigation, as well as preoperative and postoperative digital subtraction angiography (DSA). Analytical ICG-VAG is fast, easy to handle and integrates intuitively into surgical procedures. It allows colour-encoded visualization of blood flow distribution with high temporal and spatial resolution. Superficial major and minor feeding arteries can be clearly separated from the nidus and draining veins. Effects of stepwise vessel obliteration on velocity and direction of AVM blood flow can be objectified. High quality of visualization, however, is limited to the site of surgery. Colour-encoded aICG-VAG with FLOW 800 enables intraoperative real-time analysis of arterial and venous vessel architecture and might, therefore, increase efficacy and safety of neurovascular surgery in a selected subset of superficial AVMs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Bartels E, Knauth M (2006) Transcranial color-coded duplex ultrasonography of arteriovenous malformations. Rofo 178:64–70

    PubMed  CAS  Google Scholar 

  2. Ferroli P, Acerbi F, Albanese E, Tringali G, Broggi M, Franzini A, Broggi G (2011) Application of intraoperative indocyanine green angiography for CNS tumors: results on the first 100 cases. Acta Neurochir Suppl 109:251–257

    Article  PubMed  CAS  Google Scholar 

  3. Ferroli P, Acerbi F, Broggi M, Broggi G (2010) Arteriovenous micromalformation of the trigeminal root: intraoperative diagnosis with indocyanine green videoangiography: case report. Neurosurgery 67:E309–E310

    Google Scholar 

  4. Fu B, Zhao JZ, Yu LB (2008) The application of ultrasound in the management of cerebral arteriovenous malformation. Neurosci Bull 24:387–394

    Article  PubMed  Google Scholar 

  5. 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 66:978–984

    Article  PubMed  Google Scholar 

  6. Hanggi 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

    Article  PubMed  Google Scholar 

  7. Khurana VG, Seow K, Duke D (2010) Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian neurosurgical experience. Br J Neurosurg 24:163–172

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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 68:781–787

    Article  PubMed  Google Scholar 

  10. 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

    PubMed  Google Scholar 

  11. Raabe A, Beck J, Seifert V (2005) Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. Zentralbl Neurochir 66:1–6

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Schichor C, Rachinger W, Morhard D, Zausinger S, Heigl TJ, Reiser M, Tonn JC (2010) Intraoperative computed tomography angiography with computed tomography perfusion imaging in vascular neurosurgery: feasibility of a new concept. J Neurosurg 112:722–728

    Article  PubMed  Google Scholar 

  14. 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 107:416–418

    Article  PubMed  Google Scholar 

  15. Wang S, Liu L, Zhao Y, Zhang D, Yang M, Zhao J (2011) Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. Neurosurg Rev 34(2):209–215

    Article  Google Scholar 

  16. Wang Y, Wang Y, Wang Y, Taniguchi N, Chen XC (2007) Intraoperative real-time contrast-enhanced ultrasound angiography: a new adjunct in the surgical treatment of arteriovenous malformations. J Neurosurg 107:959–964

    Article  PubMed  Google Scholar 

  17. Xu HZ, Qin ZY, Gu YX, Zhou P, Chen XC (2010) Diagnostic value of contrast-enhanced intraoperative Doppler sonography for cerebral arteriovenous malformations compared with angiography. Chin Med J (Engl) 123:2812–2815

    Google Scholar 

Download references

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Klinikum Großhadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Florian Faber, Niklas Thon, Walter Rachinger, Jörg-Christian Tonn & Christian Schichor

  2. Department of Neuroradiology, Klinikum Großhadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    Gunther Fesl

  3. Carl Zeiss Surgical GmbH, Carl-Zeiss-Straße 22, 73447, Oberkochen, Germany

    Roland Guckler

Authors
  1. Florian Faber
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Niklas Thon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gunther Fesl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Walter Rachinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Roland Guckler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jörg-Christian Tonn
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christian Schichor
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Florian Faber.

Additional information

Comment

This is a well illustrated technical note on the application of the colour-encoded aICG-VAG FLOW 800 tool in AVM surgery.

Compared with conventional ICG-VAG, which has had a much larger number of patients, this paper reinforces the concept that microscope-integrated ICG angiography is a useful tool in cerebrovascular and oncological neurosurgery. The adjunct provided here is that colour-encoded visualization of blood flow distribution enhances temporal and spatial resolution, at least in a selected subset of AVMs, compared with routine ICG-VAG. The paucity in the published literature of this specific issue has made this contribution worthy of being published.

Domenico d’Avella

Alessandro Della Puppa

Padova, Italy

Rights and permissions

Reprints and permissions

About this article

Cite this article

Faber, F., Thon, N., Fesl, G. et al. Enhanced analysis of intracerebral arterioveneous malformations by the intraoperative use of analytical indocyanine green videoangiography: technical note. Acta Neurochir 153, 2181–2187 (2011). https://doi.org/10.1007/s00701-011-1141-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-011-1141-z

Keywords

Search

Navigation