Effectiveness of intraoperative near-infrared indocyanine green videoangiography in a case with recurrent spinal perimedullary arteriovenous fistula

Concerning about the treatment of spinal perimedullary arterivenous fistulas (AVFs), the goal is to obliterate the arteriovenous hunt with the preservation of the normal arterial supply and enous drainage of the spinal cord [1,3]. In order to obliterate the stula, precise identification of the fistulous point is critical. Howver, identification of the fistulous point is occasionally obscured n conventional spinal digital subtraction angiography (DSA) by verlapping dilated veins even in a primary case [3]. In the present ase which recurred at about 8 months after the initial surgery, reoperative spinal DSA could not detect the accurate shunt point ecause the flow of the shunt was low. Intraoperative spinal DSA as considered inadequate for visualizing small vessels associated ith this lesion. Therefore, we decided to utilize intraoperative ICG ideoangiography in order to identify the feeding arteries and the stula. Microscope-integrated indocyanine green (ICG) videoangiogaphy has recently reemerged as an efficient option and been idely performed to assess cerebral vascular flow [4]. To date, ICG ideoangiography has never been performed in a case of spinal erimedullary AVFs. In this report, we show the efficacy of ICG ideoangiography in a case with recurrent spinal perimedullary