Departments of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
J Neurosurg Spine. 2009 Dec;11(6):705-9. doi: 10.3171/2009.6.SPINE09315.
Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 spinal DAVF was diagnosed based on results of conventional spinal angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7-9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG angiography in vascular neurosurgery of the spine.
脊髓硬脊膜动静脉瘘（DAVF）是最常见的脊髓动静脉畸形类型，是脊柱疾病患者进行性脊髓病和发病率的重要但未被充分诊断的原因。这些病变的成功显微外科治疗取决于外科医生识别瘘管血管的能力，并确认干预后瘘管的成功闭塞。吲哚菁绿（ICG）荧光血管造影是一种用于描绘术中血管解剖结构的新兴工具，在脊柱血管疾病的治疗中有很大的潜在应用价值。作者报告了一例 76 岁男性，因双侧下肢进行性和虚弱性无力和用力时麻木而就诊，根据常规脊髓血管造影结果诊断为左侧 T-8 脊髓 DAVF。根据血管造影结果的不利解剖结构，血管内栓塞瘘管不可行，随后患者接受 T7-9 双侧椎板切除术进行显微夹闭闭塞。在夹闭放置之前，术中 ICG 荧光血管造影用于识别瘘管的动脉化静脉，在夹闭放置之后，用于确认瘘管连接的闭塞和正常血流的恢复。术中 ICG 血管造影在 DAVF 的显微外科治疗中起着重要作用。它可以用于在手术过程中实时绘制瘘管的解剖结构，并在夹闭放置后快速验证瘘管闭塞。本报告增加了越来越多的文献，证明了 ICG 血管造影在脊柱血管神经外科中的重要性。
