Safety and Efficacy of Intraoperative Indocyanine Green and Sodium Fluorescein Use in AVM Surgery

Aim: In our study, authors retrospectively analyzed the outcomes of 14 patients who underwent surgery using microsurgical techniques with the aid of intraoperative Na-Fl and ICG angiography. Our aim was to highlight the importance and advantages of using Na-Fl and ICG during AVM surgery.Material and Methods: Authors retrospectively evaluate the outcomes of 14 AVM patients who underwent surgery with the aid of Na-Fl (Akorn, Inc.) at American Hospital (Istanbul, Türkiye) and Liv Hospital (Istanbul, Türkiye) and to demonstrate the benefits provided by the use of Na-Fl (Akorn, Inc.) and ICG (Verdye, Diagnostic Green GmbH, Aschheim, Germany) during surgery. All patients underwent preoperative cerebral angiography, and their AVMs were graded according to the Spetzler-Martin classification except one patient with spinal AVM. Angioarchitecture of AVMs were identified using the Yellow 560 filter of the Kinevo 900 surgical microscope (Carl Zeiss Meditec, Oberkochen, Germany) and ICG angiography with INFRARED 800 filter. In all patients, early postoperative control digital subtraction angiography (DSA) was performed. Results: Eight (57.15%) of the patients were male and six (42.85%) were female. The mean age of the patients was 57.26 ± 21.38 years. According to the Spetzler-Martin classification, 5 patients had Grade I AVMs, 3 had Grade II, and 5 had Grade III AVMs. One patient had a glomus type cervical intramedullary AVM. Hemorrhagic AVMs were present in six (42.85%) patients, while eight (57.15%) patients had non-hemorrhagic AVMs. None of the patients required reoperation for residual AVM. Importantly, no adverse reactions or complications related to Na-Fl or ICG administration were observed in any patient, demonstrating the safety profile of these fluorescent agents at the administered doses.Conclusion: Given their complementary advantages and limitations, the combined use of these videoangiography techniques in AVM surgery offers a more comprehensive, reliable, and effective intraoperative assessment.