BACKGROUND: Spinal dural arteriovenous fistulae (dAVFs), are lesions involving an aberrant connection between a radicular feeding artery and the venous system of the spinal cord at the dural sleeve of the nerve root. When rare dAVFs are occult on digitally subtracted catheter-based angiography, they present a diagnostic and therapeutic challenge. OBJECTIVE: We report 3 cases of angiographically occult spinal dAVFs that were evaluated during surgery with indocyanine green (ICG) fluorescent microscope-integrated angiography. METHODS: Three patients with clinical and magnetic resonance imaging features suggestive of a spinal dAVF but no abnormality on digital subtraction angiography underwent surgical exploration with the aid of microscope-integrated ICG videoangiography. RESULTS: In all 3 cases, ICG identified the intradural vein draining the fistula, clearly distinguishing it from an artery or uninvolved medullary vein. CONCLUSION: ICG angiography can rapidly identify a draining vein as it enters the spinal canal even in dAVFs not identifiable on catheter-based digital subtraction angiography.
BACKGROUND:Spinal dural arteriovenous fistulae (dAVFs), are lesions involving an aberrant connection between a radicular feeding artery and the venous system of the spinal cord at the dural sleeve of the nerve root. When rare dAVFs are occult on digitally subtracted catheter-based angiography, they present a diagnostic and therapeutic challenge. OBJECTIVE: We report 3 cases of angiographically occult spinal dAVFs that were evaluated during surgery with indocyanine green (ICG) fluorescent microscope-integrated angiography. METHODS: Three patients with clinical and magnetic resonance imaging features suggestive of a spinal dAVF but no abnormality on digital subtraction angiography underwent surgical exploration with the aid of microscope-integrated ICG videoangiography. RESULTS: In all 3 cases, ICG identified the intradural vein draining the fistula, clearly distinguishing it from an artery or uninvolved medullary vein. CONCLUSION:ICG angiography can rapidly identify a draining vein as it enters the spinal canal even in dAVFs not identifiable on catheter-based digital subtraction angiography.
Authors: Michael Sabel; Johannes Knipps; Lisa Margarete Neumann; Max Kieslich; Hans-Jakob Steiger; Marion Rapp; Marcel A Kamp Journal: Neurosurg Rev Date: 2018-07-23 Impact factor: 3.042
Authors: Juan Antonio Simal Julián; Pablo Miranda Lloret; Antonio López González; Rocío Evangelista Zamora; Carlos Botella Asunción Journal: Eur Spine J Date: 2013-01-12 Impact factor: 3.134
Authors: Juan A Simal-Julián; Pablo Miranda-Lloret; Rocio Evangelista-Zamora; Pablo Sanromán-Álvarez; Laila Pérez de San Román; Pedro Pérez-Borredá; Andrés Beltrán-Giner; Carlos Botella-Asunción Journal: Neurosurg Rev Date: 2014-08-30 Impact factor: 3.042