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Indocyanine Green Videoangiography In Negative: Definition and Usefulness in Intracranial Dural Arteriovenous Fistulae

Simal Julián, Juan Antonio MD*; Miranda Lloret, Pablo PhD*; Aparici Robles, Fernando MD; Beltrán Giner, Andrés PhD*; Botella Asunción, Carlos PhD*

doi: 10.1227/NEU.0b013e318282ddd6
Technique Assessment

BACKGROUND: Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae.

OBJECTIVE: Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure.

METHODS: In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae.

RESULTS: In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization.

CONCLUSION: IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

ABBREVIATIONS: CPA, cerebellopontine angle

DSA, digital subtraction angiography

ICG, indocyanine green

IGV, indocyanine green videoangiography

IGV-IN, indocyanine green videoangiography in negative

IOA, intraoperative angiography

*Neurosurgical Department, HUyP La Fe de Valencia, Valencia, Spain

Neuroradiology Department, HUyP La Fe de Valencia, Valencia, Spain

Correspondence: J.A. Simal Julián, MD, Neurosurgical Department, Hospital La Fe, Blv Sur S/N, Valencia, Spain. E-mail:

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Received August 17, 2012

Accepted December 12, 2012

Copyright © by the Congress of Neurological Surgeons