Intraoperative indocyanine green videoangiography versus postoperative catheter angiography to confirm microsurgical occlusion of cranial dural arteriovenous fistulas.

OBJECTIVE

Intracranial dural arteriovenous fistulas (DAVFs) are diagnosed with catheter digital subtraction angiography (DSA) and confirmed intraoperatively with indocyanine green videoangiography (ICG-VA). Stand-alone ICG-VA has been demonstrated to successfully predict complete obliteration of spinal DAVFs with an associated cost reduction. The predictive value of standalone ICG-VA has not been assessed; this study sought to assess the diagnostic value of intraoperative ICG-VA versus postoperative DSA for obliteration of cranial DAVFs.

METHODS

A multi-institutional cerebrovascular database was queried for all surgically managed DAVFs. Patients who underwent both intraoperative ICG-VA and postoperative DSA were included. Demographic and radiologic data, intraoperative findings, and surgical outcome data were analyzed retrospectively.

RESULTS

Thirty-five patients with 39 DAVFs were identified (mean [SD] age: 60.3 [10.4] years; 26 [74 %] men, 9 [26 %] women). All DAVFs 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 after 28 procedures and confirmed complete obliteration in all cases. The negative predictive value of ICG-VA confirming complete occlusion of cranial DAVFs was 100 %.

CONCLUSION

Complete microsurgical occlusion of DAVFs can be confirmed using intraoperative ICG-VA. The diagnostic power of ICG-VA is underscored by its direct correlation with postoperative DSA results. The 100 % negative predictive value of ICG-VA suggests that postoperative DSA may not be necessary when intraoperative ICG-VA confirms complete occlusion of the DAVF. Forgoing postoperative DSA has the potential to save patients the procedural risk and cost associated with an additional procedure.