J Cerebrovasc Endovasc Neurosurg.  2024 Mar;26(1):. 10.7461/jcen.2023.E2023.04.007.

Surgical considerations and techniques using intraoperative indocyanine green angiography for ethmoidal dural arteriovenous fistula

• Yang HG
• Cho SH
• Kim HB
• Yang KH

• KMID: 2554040
• DOI: http://doi.org/10.7461/jcen.2023.E2023.04.007

Abstract

Objective
This study aims to investigate the efficacy of microsurgery with intraoperative indocyanine green (ICG) angiography as a treatment approach for ethmoidal dural arteriovenous fistula (DAVF).
Methods
Between January 2010 and July 2021, our institution encountered a total of eight cases of ethmoidal DAVF. In each of these cases, microsurgical treatment was undertaken utilizing a bilateral sub-frontal interhemispheric approach, with the aid of intraoperative ICG angiography.
Results
ICG angiography identified bilateral venous drainage with single dominance in four cases (50%) of ethmoidal DAVF, a finding that eluded detection during preoperative transfemoral cerebral angiography (TFCA). The application of microsurgical treatment, in conjunction with intraoperative ICG angiography, resulted in consistently positive clinical outcomes for all patients, as evaluated using the Glasgow Outcome Scale (GOS) at the 6-month postoperative follow-up assessment; six patients showed GOS score of 5, while the remaining two patients attained a GOS score of 4.
Conclusions
The use of intraoperative ICG angiography enabled accurate identification of both dominant and non-dominant venous drainage patterns, ensuring complete disconnection of the fistula and reducing the risk of recurrence.

Keyword

Ethmoid; Dural arteriovenous fistula; Microsurgery; Indocyanine green; Angiography