Comparison of Intraoperative Indocyanine Green Videoangiography vs Postoperative Catheter Angiography to Confirm Microsurgical Occlusion of Spinal Dorsal Intradural Arteriovenous Fistulas

被引:4
|
作者
Karahalios, Katherine [1 ]
Srinivasan, Visish M. [1 ]
Scherschinski, Lea [1 ]
DiDomenico, Joseph D. [1 ]
Catapano, Joshua S. [1 ]
Safaee, Michael M. [2 ]
Lawton, Michael T. [1 ]
机构
[1] St Josephs Hosp, Dept Neurosurg, Barrow Neurol Inst, Phoenix, AZ 85013 USA
[2] Univ Calif San Francisco, Dept Neurosurg, San Francisco, CA USA
关键词
Arteriovenous fistula; Digital subtraction angiography; Dorsal intradural arteriovenous fistula; Indocyanine green videoangiography; Type 1 arteriovenous fistula; SURGICAL-TREATMENT; CLASSIFICATION; MALFORMATIONS;
D O I
10.1227/ons.0000000000000302
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
BACKGROUND: Dorsal intradural arteriovenous fistulas (DI-AVFs) represent 80% of spinal AVFs. Microsurgical clip occlusion is a durable treatment that uses preoperative and postoperative digital subtraction angiography (DSA) as standard practice. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable intraoperative adjunct in these cases. Intraoperative ICG-VA findings have not been compared with postoperative DSA findings. OBJECTIVE: To assess the diagnostic value of intraoperative ICG-VA vs postoperative DSA for spinal DI-AVFs. METHODS: A multi-institutional database of vascular malformations was queried for all surgically managed cases of DI-AVF. Patients with both intraoperative ICG-VA and postoperative DSA were included. Demographic and radiologic data, intraoperative findings, and surgical outcomes data were retrospectively analyzed. RESULTS: Forty-five patients with DI-AVF were identified (male sex, 32; mean age, 61.9 [range, 26-85] years). All DI-AVFs were treated with interruption of the fistula with clip occlusion of the draining vein. Intraoperative ICG-VA showed complete obliteration in all patients. Postoperative DSA was performed for 40 patients and confirmed complete obliteration in all patients. The negative predictive value of ICG-VA confirming complete occlusion of the DI-AVFs was 100%. Eighteen patients (47%) experienced clinical improvement, and 16 (42%) experienced no change in condition. CONCLUSION: ICG-VA is useful for intraoperative identification of DI-AVFs and confirmation of complete microsurgical occlusion. Correlation between intraoperative ICG-VA and postoperative DSA findings demonstrates the diagnostic power of ICG-VA. This finding suggests that postoperative DSA is unnecessary when intraoperative ICG-VA confirms complete occlusion of the DI-AVF, which will spare patients the procedural risk and cost of this invasive procedure.
引用
收藏
页码:206 / 211
页数:6
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