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. 2017 Oct-Dec;12(4):638-643.
doi: 10.4103/ajns.AJNS_62_14.

Intraoperative Anatomical and Hemodynamic Analysis of Intracerebral Arteriovenous Malformations by Semi-quantitative Color-coded Indocyanine Green Videoangiography

Yoko Kato  1 , Yasuhiro Yamada  1 , Akiyo Sadato  1 , Mohsen Nouri  2 , Iype Cherian  3 , Teppei Tanaka  1 , Joji Inamasu  1
Affiliations

Intraoperative Anatomical and Hemodynamic Analysis of Intracerebral Arteriovenous Malformations by Semi-quantitative Color-coded Indocyanine Green Videoangiography

Yoko Kato et al. Asian J Neurosurg. 2017 Oct-Dec.

Abstract

Objective and background: To evaluate possible roles for indocyanine green (ICG)-based FLOW 800 software in surgical treatment of cerebral arteriovenous malformations (AVMs).

Methods: We perform ICG videoangiography several times for each step of AVM resection to elucidate feeders, drainers, and cerebral perfusion.

Results: Since 2010, 22 AVM surgeries in our department have been conducted using FLOW 800 intraoperatively. We demonstrated ICG angiograms, color-coded images, and semi-quantitative curves for AVMs. By reviewing all these modalities, we would define vascular structure of the AVM, proceed with resection, and finally recheck for any remnant.

Conclusions: ICG FLOW 800 software helps the surgeon to recognize feeding and draining vessels of an AVM intraoperatively. Further studies to evaluate semi-quantitative acquired data regarding blood flow and tissue perfusion are warranted.

Keywords: Cerebral arteriovenous malformation; cerebral blood flow; drainer; feeder; indocyanine green videoangiography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Right parietal arteriovenous malformation in a 55-year-old man. (a) Reconstructed computed tomography angiogram shows the location, feeding artery, and draining vein of the arteriovenous malformation. (b) After opening the dura, the lesion appears on the brain cortex. (c) Videoangiography after indocyanine green injection immediately after dural opening. (d) Color-coded image after analysis of Figure 1c with FLOW 800. (e) Color-coded imaging after ablation of some feeding arteries. Note the color changes in the vessels indicating hemodynamic changes of the arteriovenous malformation. (f) Color-coded imaging after complete resection of the arteriovenous malformation confirming no remnant of the lesion
Figure 2
Figure 2
A cerebellar arteriovenous malformation in a 62-year-old man. (a) Indocyanine green videoangiography after exposing the lesion. Different vessels have been marked for the software to compute their hemodynamic properties. (b) Color-coded image of the same view in Figure 2a produced with FLOW 800 software. The blood flow is depicted in range of color from red to blue depending on the arrival time. (c) Analysis of the markers in Figure 2a is demonstrated in curves. Arterial flow reaches its peak earlier than venous blood flow. (d-f) The same images as Figure 2a-c after resection for comparison. Compare the color of the vasculature before [Figure b] and after (e) resection of the arteriovenous malformation. (f) Curves indicate hemodynamic changes in vessels after arteriovenous malformation resection
Figure 3
Figure 3
Hemodynamic properties of blood flow in a vessel after image analysis by ImageJ. Maximum fluorescence intensity is defined as the highest intensity of fluorescence for a defined area, and time to peak is the time interval from the appearance of fluorescence until its peak. Rise time is the time interval when fluorescence intensity rises from 10% to 90% of maximum fluorescence intensity. Cerebral blood flow index is calculated as the ratio of maximum fluorescence intensity to real time
See this image and copyright information in PMC

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