Patient Outcomes Following Obliteration of Spinal Dural Arteriovenous Fistula and the Role of Indocyanine Green Angiography Videoangiography (ICG‑VA) During Surgery

Abstract

Background: Spinal dural arteriovenous fistula (SDAVF) is a known cause of progressive myelopathy which can be treated either by surgery or embolization. Indocyanine green angiography videoangiography (ICG-VA) during surgery can locate the exact location of AV shunting. Objective: To determine the clinical outcome following obliteration of the fistula and to study the role of ICG in identifying the presence and location of SDAVF; to add a comparative study of patients treated by embolization. Materials and Methods: Patients treated for SDAVF in our centre from 2005 to 2015 were studied for clinical and radiological features, and outcome following obliteration of fistula. Results: Of the total 33 patients (27 males, six females), 19 patients were operated without the use of ICG, nine were operated with the use of ICG and successful embolization was done in five. Acute presentation was seen in five. Single feeder was seen in 20 patients, multiple in 13. Mean follow-up was 58 months. All patients in ICG group improved. Three out of 19 patients in the non-ICG group (15.78%) required re-operation. With the use of ICG, the improvement in Aminoff Logue score was significantly better (P < 0.005). Embolization was tried in 13 cases, but successful in five (38%). Conclusions: Surgery with intraoperative ICG shows the exact location of AVF. This decreases the chance of postoperative clinical deterioration and improves patient outcome.