Sasaki Keisuke, Endo Hidenori, Niizuma Kuniyasu, Nishijima Yasuo, Osawa Shinichiro, Fujimura Miki, Tominaga Teiji
Departments of Neurosurgery, Graduate School of Medicine, Tohoku University, Japan.
Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Japan.
Surg Neurol Int. 2020 Mar 13;11:46. doi: 10.25259/SNI_588_2019. eCollection 2020.
In this study, we report a case of dural arteriovenous fistula (dAVF) that was successfully treated using intra-arterial indocyanine green (IA-ICG) videoangiography during open surgery. Moreover, the findings of IA-ICG videoangiography were compared with those of intraoperative digital subtraction angiography (DSA).
A 72-year-old male patient with a history of hypertension, hyperlipidemia, and thrombocytosis presented with generalized seizure. DSA revealed Cognard Type III dAVF in the superior wall of the left transverse sinus, which was fed by a single artery (the left occipital artery [OA]) and drained into a single vein (the left temporal cortical vein), without drainage into a venous sinus. Since transarterial embolization was considered challenging due to the tortuosity of the left OA, surgical interruption of the shunt was performed by craniotomy. After excising the feeding artery, we were unable to observed dAVF on intraoperative DSA. However, IA-ICG videoangiography revealed the remaining shunt, which was fed by the collateral route from the feeding artery. The shunting point and draining vein were then surgically resected to eliminate the shunt. The shunt was not observed during the second IA-ICG videoangiography conducted after resection.
ICG videoangiography is a better method compared with DSA in terms of visualizing fine vascular lesions. In contrast to the typical intravenous administration, selective IA-ICG can be repeatedly injected at a minimal dose. IA-ICG is a useful intraoperative tool that can be used to evaluate the elimination of the dAVF.
在本研究中，我们报告了一例硬脑膜动静脉瘘（dAVF）患者，该患者在开颅手术期间使用动脉内吲哚菁绿（IA-ICG）血管造影成功治疗。此外，还将IA-ICG血管造影的结果与术中数字减影血管造影（DSA）的结果进行了比较。
一名72岁男性患者，有高血压、高脂血症和血小板增多症病史，出现全身性癫痫发作。DSA显示左侧横窦上壁存在Cognard III型dAVF，由单一动脉（左侧枕动脉[OA]）供血，并引流至单一静脉（左侧颞叶皮质静脉），无静脉窦引流。由于左侧OA迂曲，经动脉栓塞被认为具有挑战性，因此通过开颅手术进行分流的手术中断。切除供血动脉后，我们在术中DSA上未观察到dAVF。然而，IA-ICG血管造影显示了剩余的分流，其由供血动脉的侧支途径供血。然后通过手术切除分流点和引流静脉以消除分流。在切除后进行的第二次IA-ICG血管造影中未观察到分流。
在可视化微小血管病变方面，ICG血管造影是一种比DSA更好的方法。与典型的静脉给药不同，选择性IA-ICG可以以最小剂量重复注射。IA-ICG是一种有用的术中工具，可用于评估dAVF的消除情况。
