A tenant of any neurosurgical operation is the maintenance of perfusion by way of avoiding undue vascular compromise. In the resection of intracerebral arteriovenous malformations (AVMs), this means the exclusion of en passage (i.e., uninvolved) vessels as well as the protection of nidal draining veins until arterial feeders have been disconnected (1). Indocyanine green (ICG) is a non-specific fluorescein-like dye that can be injected systemically to help delineate the margins of vascular anatomy under direct visualization and represents one such maneuver to successfully accomplish these goals. ICG videoangiography (VA) specifically is useful in this endeavor in that it enables the operator to directly and immediately assess the integrity of vessels under the intraoperative microscope.
Since its introduction to the field, the utility of ICG VA in optimizing the margins of safety during AVM resection has become more widely accepted. Now, some authors would posit that ICG VA is a standard component of AVM resection surgery (2). Both single-institution (3) and expert-driven (1) reports of the practicality of ICG VA as an intraoperative armament have been bolstered by larger reviews of the topic by various research cooperatives in recent years (2, 4, 5). A contemporaneous review of the topic is warranted to refresh neurosurgeons' understanding of ICG's important role in neurosurgery as it relates to AVM resection surgery and to provide an updated synthesis of available data.
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