Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arterovenous Fistula: A Useful Application

Background: Indocyanine green videoangiography (ICG-V) is used with increasing frequency in neurovascular surgery. ICG-V use in spinal dural arteriovenous fistulas (DAVFs) allows visualization of the hemodynamics of the fistula and to confirm its exclusion after ligation of the feeder. Here, we illustrate how ICG-V is useful for centering the surgical exposure during mini-invasive approaches to spinal DAVFs. Methods: An overweight 66-year-old woman with progressive paraparesis and sphincter disturbances underwent treatment for a spinal DAVF fed by the left T6 radicular artery. After intraoperative fluoroscopy, T6 hemilaminectomy was performed. Because of slight misplacement of the bone opening, the feeder was not visible at the dural opening. We placed a temporary clip on a perimedullary arterialized vein and performed ICG-V while removing the clip. Results: Reviewing the video clip and analyzing the direction of ICG flow inside the perimedullary venous plexus allowed us to locate the fistula with respect to the bone window and to extend the laminectomy in the correct direction. Conclusions: IGC-V can be helpful in mini-invasive approaches to spinal DAVFs to recalibrate the bone opening after misplacement of the initial hemilaminectomy.