Ahead of Print: ICG in the Surgical Management of Cerebral Arteriovenous Malformations

Screen Shot 2014-03-03 at 2.26.53 PMBackground: Indocyanine green (ICG) angiography is commonly used to map the vascular configuration of cerebral arteriovenous malformations (AVM) during resection.

Objective: To determine whether ICG improves rates of resection and clinical outcomes.

Methods: A retrospective chart review on all patients undergoing resection of an AVM by the senior author (RFS) between 2007-2011. Operative reports, hospital records, and radiographic imaging were used to determine utilization of ICG, incidence of residual disease, and clinical outcomes.

Results: A total of 130 cases (56 ICG, 74 non-ICG) were identified. Average AVM grade (2.2 vs 2.4) and size (2.7 cm vs 2.7 cm) was similar between ICG and non-ICG groups, respectively. ICG was more often used when the AVM nidus was close to the cortical surface (71.4% vs 17.6%, p-value 0.001) or lobar (82.1% vs 54.1%, p-value 0.008). 18 patients (13.8%) were noted to have residual disease. Re-operation rates and change in mRS were no different between the two groups (12.5% vs 14.9%, p-value=0.8, 0.6 vs 0.4, p-value 0.171). There were no ICG-attributable complications.

Conclusion: ICG videoangiography is a quick and safe method of intraoperatively mapping the angioarchitecture of superficial AVMs, but less helpful for deep-seated lesions. This modality alone does not improve identification of residual disease or clinical outcomes. Surgeon experience with extensive study of preoperative vascular imaging is paramount to achieving acceptable clinical outcomes. Formal angiography remains the gold standard for evaluation of AVM obliteration.

From: Indocyanine Green Angiography in the Surgical Management of Cerebral Arteriovenous Malformations: Lessons Learned in 130 Consecutive Cases by Zaidi et al.

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