Intra-arterial injection of indocyanine green in cerebral arteriovenous malformation surgery.

Surgical microscope-integrated intraoperative angiography with intra-venous injection of indocyanine green (ICG) has been widely used during bypass or aneurysm surgery. Instead of intra-venous injection of ICG, we describe a case of intraoperative video angiography with intra-arterial injection of ICG in cerebral arteriovenous malformation (AVM) surgery. During the surgery, we injected ICG through a catheter placed in the internal carotid artery in each step. The technique was feasible and useful to distinguish feeders from normal arteries and to observe changes in flow dynamics. Intra-arterial injection of ICG had better phase contrast than intra-venous injection of ICG and better spatial resolution than digital subtraction angiography. Therefore, this technique can be helpful in cerebral AVM surgery.