Intraoperative indocyanine green videoangiography versus postoperative catheter angiography to confirm microsurgical occlusion of cranial dural arteriovenous fistulas

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Clinical Neurology and Neurosurgery Pub Date : 2025-04-14 DOI:10.1016/j.clineuro.2025.108896

Katherine Karahalios , Lea Scherschinski , Visish M. Srinivasan , Joseph H. Garcia , Rohin Singh , Adam T. Eberle , Joelle N. Hartke , Joshua S. Catapano , Redi Rahmani , Christopher S. Graffeo , Michael T. Lawton

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引用次数: 0

Abstract

Objective

Intracranial dural arteriovenous fistulas (DAVFs) are diagnosed with catheter digital subtraction angiography (DSA) and confirmed intraoperatively with indocyanine green videoangiography (ICG-VA). Stand-alone ICG-VA has been demonstrated to successfully predict complete obliteration of spinal DAVFs with an associated cost reduction. The predictive value of standalone ICG-VA has not been assessed; this study sought to assess the diagnostic value of intraoperative ICG-VA versus postoperative DSA for obliteration of cranial DAVFs.

Methods

A multi-institutional cerebrovascular database was queried for all surgically managed DAVFs. Patients who underwent both intraoperative ICG-VA and postoperative DSA were included. Demographic and radiologic data, intraoperative findings, and surgical outcome data were analyzed retrospectively.

Results

Thirty-five patients with 39 DAVFs were identified (mean [SD] age: 60.3 [10.4] years; 26 [74 %] men, 9 [26 %] women). All DAVFs 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 after 28 procedures and confirmed complete obliteration in all cases. The negative predictive value of ICG-VA confirming complete occlusion of cranial DAVFs was 100 %.

Conclusion

Complete microsurgical occlusion of DAVFs can be confirmed using intraoperative ICG-VA. The diagnostic power of ICG-VA is underscored by its direct correlation with postoperative DSA results. The 100 % negative predictive value of ICG-VA suggests that postoperative DSA may not be necessary when intraoperative ICG-VA confirms complete occlusion of the DAVF. Forgoing postoperative DSA has the potential to save patients the procedural risk and cost associated with an additional procedure.

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术中吲哚菁绿血管造影与术后导管血管造影确认显微手术闭塞颅硬膜动静脉瘘的比较

目的应用导管数字减影血管造影（DSA）诊断颅内硬脑膜动静脉瘘（DAVFs），术中应用吲哚菁绿血管造影（ICG-VA）确诊。独立的ICG-VA已被证明可以成功预测脊柱davf的完全闭塞，并降低相关成本。独立的ICG-VA的预测价值尚未评估；本研究旨在评估术中ICG-VA与术后DSA对颅脑davf闭塞的诊断价值。方法查询多机构脑血管数据库中所有手术处理的davf。同时进行术中ICG-VA和术后DSA的患者纳入研究。回顾性分析人口学和放射学资料、术中发现和手术结果资料。结果35例39例davf患者(平均[SD]年龄：60.3[10.4]岁；男性26[74 %]，女性9[26 %])。所有davf均采用夹住引流静脉阻断瘘管的方法治疗。术中所有患者的ICG-VA均显示完全闭塞。术后28例均行DSA，证实所有病例完全闭塞。ICG-VA对颅内davf完全闭塞的阴性预测值为100% %。结论术中ICG-VA可证实显微外科手术对davf的完全闭塞。ICG-VA的诊断能力与术后DSA结果直接相关。ICG-VA阴性预测值为100% %，提示术中ICG-VA确认DAVF完全闭塞时，术后DSA可能不需要。放弃术后DSA有可能为患者节省与额外手术相关的手术风险和费用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Neurology and Neurosurgery 医学-临床神经学

CiteScore

3.70

自引率

5.30%

发文量

358

审稿时长

46 days

期刊介绍： Clinical Neurology and Neurosurgery is devoted to publishing papers and reports on the clinical aspects of neurology and neurosurgery. It is an international forum for papers of high scientific standard that are of interest to Neurologists and Neurosurgeons world-wide.