Neurosurgical Department, HUyP La Fe de Valencia, Blv Sur, S/N., Valencia, Spain.
Eur Spine J. 2013 May;22 Suppl 3(Suppl 3):S471-7. doi: 10.1007/s00586-012-2646-8. Epub 2013 Jan 12.
Indocyanine green videoangiography (IGV) has proven its effectiveness in the field of exovascular neurosurgery, both in the intracranial and spinal compartment, but is necessary to define a systematic process for the performance of the IGV to facilitate its interpretation during the procedure. We have defined and applied the concept of videoangiography "in negative" (INIGV) to spinal dural arteriovenous fistulae (dAVF) for the detection and treatment of arteriovenous shunts, so called because the first phase is performed with the vessel suggestive of being pathological occluded.
A Pentero-operating microscope with near-infrared IGV-integrated system (Carl Zeiss Co., Germany) was used. At our institution, 24 patients were treated for a spinal dAVF between 1995 and 2011, only in the last 4 cases, INIGV was performed.
We describe the IGV in negative procedure and show the most illustrative cases. In all cases, the fistula occlusion was confirmed by postoperative selective digital subtraction angiography (DSA). INIGV demonstrate its capacity in detecting vessels not actually arterialized that should be respected and avoid some of the main limitations of the conventional IGV. This is a technical description about an Indocyanine green (ICG) videoangiographic procedure modification that is superior to merely performing ICG before and after clipping of a dAVF.
The INIGV results are rapid and easy to interpret procedure and provide great advantages to the dAVF treatment. Nevertheless, further studies are needed with a larger sample size to determine if INIGV may reduce the need to perform immediate postoperative DSA.
吲哚菁绿视频血管造影（ICG）已被证明在颅外神经外科领域具有有效性，无论是在颅内还是脊髓区域，但需要定义一个系统的 ICG 执行流程，以方便在手术过程中进行解释。我们已经定义并应用了脊髓硬脑膜动静脉瘘（dAVF）的视频血管造影“负向”（INIGV）概念，用于检测和治疗动静脉分流，之所以这样命名，是因为第一阶段是对疑似存在病理性闭塞的血管进行检查。
使用集成近红外 ICG 的 Pentero 手术显微镜（德国卡尔蔡司公司）。在我们的机构中，1995 年至 2011 年间，有 24 名患者因脊髓 dAVF 接受治疗，仅在最后 4 例中进行了 INIGV。
我们描述了负向 IGV 程序，并展示了最具代表性的病例。在所有病例中，瘘口闭塞均通过术后选择性数字减影血管造影（DSA）得到证实。INIGV 显示了其检测实际上未动脉化的血管的能力，这些血管应受到尊重，并避免了传统 IGV 的一些主要限制。这是一项关于吲哚菁绿（ICG）视频血管造影程序修改的技术描述，优于仅在夹闭 dAVF 前后进行 ICG 检查。
INIGV 是一种快速且易于解释的程序，为 dAVF 治疗提供了巨大优势。然而，需要进一步进行更大样本量的研究，以确定 INIGV 是否可以减少对立即进行术后 DSA 的需求。
