Microarteriovenous Malformations-Value of Indocyanine Green Fluorescence and Nuances of Surgical Excision: 2-Dimensional Operative Video.

Abstract

MicroAVMs (microarteriovenous malformation) are arteriovenous shunts with a nidus smaller than 1 centimeter.1 They are typically diagnosed after hemorrhage. When the nidus is very small, diagnosis can be challenging even on catheter angiography and careful examination of the arterial and capillary phases is required to identify the early shunt. Because of the very small size, identification and localization of the actual AV shunt can be problematic during surgical exploration. Advances in frameless stereotactic neuronavigation and the introduction of intraoperative indocyanine green (ICG) fluorescein provide useful adjuncts in the surgical treatment of these relatively uncommon lesions. In this video, we present 2 cases which document the value of intraoperative ICG fluorescein as well as some of the surgical pitfalls in the treatment of these lesions.