caa a22 4500 606214992 CHVBK 20210128101056.0 cr unu---uuuuu 210128e20150301xx s 000 0 eng 10.1007/s00701-014-2287-2 doi (NATIONALLICENCE)springer-10.1007/s00701-014-2287-2 Comparison of indocyanine green fluorescent angiography to digital subtraction angiography in brain arteriovenous malformation surgery [Elektronische Daten] [Christopher Bilbao, Tarun Bhalla, Shamsher Dalal, Hiren Patel, Amir Dehdashti] Background: The potential utility of intraoperative microscope-integrated indocyanine green (ICG) fluorescence angiography in the surgery of brain arteriovenous malformations (AVMs) and evaluation of the completeness of resection is debatable. Postoperative catheter angiography is considered the gold standard. We evaluated the value of ICG and intraoperative catheter angiography in this setting. Methods: Between January 2009 and July 2013, 37 patients with brain AVMs underwent surgical resection of their vascular lesions. ICG videoangiography and an intraoperative catheter angiography were performed in 32 cases, and a routine postoperative angiogram was performed within 48h to 2weeks after surgery. The usefulness of ICG findings and the ability to confirm total resection and to identify residual nidus or persistent shunt were assessed and compared to intraoperative and postoperative digital subtraction angiography, respectively. Results: There were 7 grade 1, 11 grade 2, 11 grade 3 and 3 grade 4 Spetzler-Martin classification AVMs. ICG angiography helped to distinguish AVM vessels in 26 patients. In 31 patients, it demonstrated that there was no residual shunting. In one patient, a residual AVM was identified and further resected. Intraoperative catheter angiography detected two additional small residuals that were missed by ICG angiography, both deep in the surgical cavity. Further resection of the AVM was performed, and total resection was confirmed by a repeat intraoperative angiogram. Postoperative angiography in a patient with a grade 4 lesion revealed one additional small deep residual AVM nidus with persistent late shunting missed on both ICG and intraoperative angiography. Overall ICG angiography missed three out of four residual AVMs after initial resection, while the intraoperative angiogram missed one. Conclusion: Although ICG angiography is a helpful adjunct in the surgery of some brain AVMs, it's yield in detecting residual AVM nidus or shunt is low, especially for deep-seated lesions and higher grade AVMs. ICG angiography should not be used as a sole and/or reliable technique. High-resolution postoperative angiography must be performed in brain AVM surgery and remains the best test to confidently confirm complete AVM resection. Springer-Verlag Wien, 2014 Brain arteriovenous malformation nationallicence Fluorescence angiography nationallicence Indocyanine green videoangiography nationallicence Catheter angiography nationallicence Intraoperative nationallicence Bilbao Christopher Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, 19131, Philadelphia, PA, USA aut Bhalla Tarun Department of Neurosurgery, Geisinger Medical Center, 100 N. Academy Ave, 17822, Danville, PA, USA aut Dalal Shamsher Department of Neurosurgery, Geisinger Medical Center, 100 N. Academy Ave, 17822, Danville, PA, USA aut Patel Hiren Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, 19131, Philadelphia, PA, USA aut Dehdashti Amir Department of Neurosurgery, North Shore University Hospital, 300 Community Dr., 11030, Manhasset, NY, USA aut Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 351-359 0001-6268 157:3<351 2015 157 701 https://doi.org/10.1007/s00701-014-2287-2 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00701-014-2287-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bilbao Christopher Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, 19131, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Bhalla Tarun Department of Neurosurgery, Geisinger Medical Center, 100 N. Academy Ave, 17822, Danville, PA, USA aut NATIONALLICENCE 700 1- Dalal Shamsher Department of Neurosurgery, Geisinger Medical Center, 100 N. Academy Ave, 17822, Danville, PA, USA aut NATIONALLICENCE 700 1- Patel Hiren Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, 4190 City Avenue, 19131, Philadelphia, PA, USA aut NATIONALLICENCE 700 1- Dehdashti Amir Department of Neurosurgery, North Shore University Hospital, 300 Community Dr., 11030, Manhasset, NY, USA aut NATIONALLICENCE 773 0- Acta Neurochirurgica Springer Vienna 157/3(2015-03-01), 351-359 0001-6268 157:3<351 2015 157 701