Intraoperative indocyanine green video-angiography: spinal dural arteriovenous fistula

Technical note. To describe the use of intraoperative indocyanine green (ICG) video-angiography for obliteration of a spinal dural arteriovenous fistula (DAVF) and to show a video clip. ICG video-angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has a significant potential in the treatment of vascular diseases in the spine. The authors presented a case of a 73-year-old man with progressive and debilitating bilateral lower extremity weakness. The patient was diagnosed with a spinal DAVF of 10th thoracic spine based on the results of conventional spinal angiography. The patient underwent T9-10 laminotomy for microsurgical clip occlusion. Intraoperative ICG video-angiography was used before clip placement to identify the arterialized veins of the fistula and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG video-angiography serves an important role in the microsurgical treatment of DAVF. It is simple and provides real-time information about the precise location of spinal DAVF and result after obliteration of spinal DAVF.