Abstract
Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.
Highlights
Patients with arteriovenous malformation (AVM) are usually treated by means of direct surgery, endovascular embolization, or stereotactic radiotherapy, of which direct surgery is most effective to improve the patients’ long-term prognosis
Intraoperative indocyanine green (ICG) videoangiography has become an indispensable tool for use in patients undergoing neurovascular surgery [5,6,7,8]
Kamp et al reported mean values of the parameters in patients undergoing different surgical procedures, including treatment of aneurysm, brain ischemia, and AVM, using the time-intensity diagram of ICG; with regard to each parameter, the results indicated significant differences between the normal brain cortex and the less perfused areas [14]
Summary
Patients with arteriovenous malformation (AVM) are usually treated by means of direct surgery, endovascular embolization, or stereotactic radiotherapy, of which direct surgery is most effective to improve the patients’ long-term prognosis. FLOW800 (Zeiss OPMI Pentero, Carl Zeiss Meditec, Oberkochern, Germany), a newly developed analytical tool in ICG videoangiography, has recently become available for clinical use to obtain qualitative visualization of the blood flow and vessel strength [9,10,11]. This function provides useful information about the operative fields’ structure with detailed color-coded images, as well as semi-quantitative data through time-intensity curves for analysis of the blood flow parameters of target areas [12, 13]. Stroke Research and Treatment our study aimed to validate the function of FLOW800 in treatment procedures of the AVM under clinical setting and comparatively evaluate semi-quantitative parameters in the individual vessels of AVMs with specific characteristics
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