• Kenji Shimada, Kazuhisa Miyake, Izumi Yamaguchi, Shu Sogabe, Masaaki Korai, Yasuhisa Kanematsu, and Yasushi Takagi.
• Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan. Electronic address: s_kenji1032@yahoo.co.jp.
• World Neurosurg. 2023 Jan 1; 169: e260e269e260-e269.

ObjectiveAn understanding of the complex morphology of an arteriovenous malformation (AVM) is important for successful resection. We have previously reported the utility of intra-arterial indocyanine green (ICG) videoangiography for this purpose, but that method cannot detect the angioarchitecture covered by brain tissue. 3-dimensional (3D) multimodal fusion imaging is reportedly useful for this same purpose, but cannot always visualize the exact angioarchitecture due to poor source images and processing techniques. This study examined the results of utilizing both techniques in patients with AVMs.MethodsBoth techniques were applied in 12 patients with AVMs. Both images were compared with surgical views and evaluated by surgeons.ResultsAlthough evaluations for identifying superficial feeders by ICG videoangiography were high in all cases, the more complicated the AVM, the lower the evaluation by 3D multimodal fusion imaging. Conversely, evaluation of the estimated range of the nidus was high in all cases by 3D multimodal fusion imaging, but low in all but one case by ICG videoangiography. Nidus flow reduction was recognized by Flow 800 analysis obtained after ICG videoangiography.ConclusionsThese results showed that utilizing both techniques together was more useful than each modality alone in AVM surgery. This was particularly effective in identifying superficial feeders and estimating the range of the nidus. This technique is expected to offer an optimal tool for AVM surgery.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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