Fluorescein-Guided Surgery for Arteriovenous Malformation.

Area of Science:

• Neurosurgery
• Medical Imaging
• Vascular Surgery

Background:

• Fluorescence videoangiography (VAG) using indocyanine green or fluorescein (FL) aids cerebrovascular surgery.
• Indocyanine green-VAG is established for arteriovenous malformation (AVM) treatment, while FL-VAG is underrepresented in literature.

Observation:

• A case report details the use of FL-VAG in a 33-year-old woman with a grade 1 frontal unruptured AVM.
• FL-VAG was administered at three critical junctures: pre-dissection, post-feeder disconnection, and post-nidus removal.

Findings:

• FL-VAG successfully visualized superficial AVM vessels and draining veins.
• Diminished blood flow was observed after feeder artery disconnection.
• Complete AVM removal was confirmed by the absence of FL in the surgical bed post-excision.

Implications:

• FL-VAG is a valuable adjunct for AVM resection, enabling real-time assessment of cerebral blood flow.
• It assists in surgical decision-making, such as identifying main feeders versus arteries in passage.
• This technique can optimize surgical strategy and potentially reduce operative time.