• Soichiro Takamiya, Kazuyoshi Yamazaki, Kikutaro Tokairin, Toshiya Osanai, Takashi Shindo, Toshitaka Seki, and Miki Fujimura.
• Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. Electronic address: soichiro.tkmy@gmail.com.
• World Neurosurg. 2021 Jul 1; 151: 132-137.

BackgroundIt is crucial to identify a shunt point for spinal arteriovenous malformation (AVM) treatment. For this purpose, some intraoperative supports have been reported-intravenous injection of indocyanine green (ICG), selective arterial injection of ICG, and selective arterial injection of saline with a high frame rate digital camera. However, there are difficulties in accurately identifying the shunt point, especially if the lesion has multiple feeders. The aim of this technical note was to report a novel method, selective arterial injection of saline to subtract signals of ICG, to precisely identify perimedullary arteriovenous fistula shunt points having multiple feeding arteries.MethodsAfter exposing the lesion, a 4-F catheter was cannulated into the origins of the segmental artery. ICG was injected intravenously as a first step, and then heparinized saline solution was flushed from the catheter.ResultsCompared with other methods, this method could identify the exact shunt point and was effective for certain shunt point obliterations.ConclusionsDespite having similar invasiveness, selective arterial injection of saline to subtract signals of ICG is superior to previously described techniques, such as selective arterial injection of ICG. Therefore, it will be useful in spinal arteriovenous malformation surgical treatment.Copyright © 2021 Elsevier Inc. All rights reserved.

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