Karahalios Katherine, Srinivasan Visish M, Scherschinski Lea, DiDomenico Joseph D, Catapano Joshua S, Safaee Michael M, Lawton Michael T
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA.
Oper Neurosurg (Hagerstown). 2022 Sep 1;23(3):206-211. doi: 10.1227/ons.0000000000000302. Epub 2022 Jul 6.
Dorsal intradural arteriovenous fistulas (DI-AVFs) represent 80% of spinal AVFs. Microsurgical clip occlusion is a durable treatment that uses preoperative and postoperative digital subtraction angiography (DSA) as standard practice. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable intraoperative adjunct in these cases. Intraoperative ICG-VA findings have not been compared with postoperative DSA findings.
To assess the diagnostic value of intraoperative ICG-VA vs postoperative DSA for spinal DI-AVFs.
A multi-institutional database of vascular malformations was queried for all surgically managed cases of DI-AVF. Patients with both intraoperative ICG-VA and postoperative DSA were included. Demographic and radiologic data, intraoperative findings, and surgical outcomes data were retrospectively analyzed.
Forty-five patients with DI-AVF were identified (male sex, 32; mean age, 61.9 [range, 26-85] years). All DI-AVFs 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 for 40 patients and confirmed complete obliteration in all patients. The negative predictive value of ICG-VA confirming complete occlusion of the DI-AVFs was 100%. Eighteen patients (47%) experienced clinical improvement, and 16 (42%) experienced no change in condition.
ICG-VA is useful for intraoperative identification of DI-AVFs and confirmation of complete microsurgical occlusion. Correlation between intraoperative ICG-VA and postoperative DSA findings demonstrates the diagnostic power of ICG-VA. This finding suggests that postoperative DSA is unnecessary when intraoperative ICG-VA confirms complete occlusion of the DI-AVF, which will spare patients the procedural risk and cost of this invasive procedure.
硬脊膜内背侧动静脉瘘（DI-AVFs）占脊髓动静脉瘘的80%。显微外科夹闭术是一种持久的治疗方法，术前和术后数字减影血管造影（DSA）是其标准操作。术中吲哚菁绿视频血管造影（ICG-VA）在这些病例中是一种有价值的术中辅助手段。术中ICG-VA的结果尚未与术后DSA的结果进行比较。
评估术中ICG-VA与术后DSA对脊髓DI-AVFs的诊断价值。
查询一个多机构血管畸形数据库，以获取所有接受手术治疗的DI-AVF病例。纳入同时有术中ICG-VA和术后DSA的患者。对人口统计学和放射学数据、术中发现以及手术结果数据进行回顾性分析。
确定了45例DI-AVF患者（男性32例；平均年龄61.9岁[范围26 - 85岁]）。所有DI-AVFs均通过夹闭引流静脉来中断瘘管进行治疗。术中ICG-VA显示所有患者瘘管完全闭塞。40例患者进行了术后DSA，证实所有患者均完全闭塞。ICG-VA确认DI-AVFs完全闭塞的阴性预测值为100%。18例患者（占47%）临床症状改善，16例患者（占42%）病情无变化。
ICG-VA有助于术中识别DI-AVFs并确认显微外科完全闭塞。术中ICG-VA与术后DSA结果的相关性证明了ICG-VA的诊断能力。这一发现表明，当术中ICG-VA确认DI-AVF完全闭塞时，术后DSA是不必要的，这将使患者免受这种侵入性检查的操作风险和费用。
