■ OBJECTIVE: Spinal dorsal intradural arteriovenous fis-tulas (DI-AVFs) represent 70% of all spinal vascular le-sions. Diagnostic tools include pre-and postoperative digital subtraction angiography (DSA) and intraoperative indocyanine green videoangiography (ICG-VA). ICG-VA has a high predictive value in DI-AVF occlusion, but post-operative DSA remains a core component of postoperative protocols. The aim of this study was to evaluate the po-tential cost reduction of forgoing postoperative DSA after microsurgical occlusion of DI-AVFs. ■ METHODS: Cohort-based cost effectiveness study of all DI-AVFs within a prospective, single-center cerebrovas-cular registry from January 1, 2017, to December 31, 2021. ■ RESULTS: Complete data including intraoperative ICG-VA and costs were available for 11 patients. Mean (SD) age was 61.5 (14.8) years. All DI-AVFs were treated with microsurgical clip ligation of the draining vein. ICG-VA showed complete obliteration in all patients. Post-operative DSA was performed for 6 patients and confirmed complete obliteration. Mean (SD) cost contributions for DSA and ICG-VA were $11,418 ($4,861) and $12 ($2), respectively. Mean (SD) total costs were $63,543 ($15,742) and $53,369 ($27,609) for patients who did and did not un-dergo postoperative DSA, respectively. Comorbidity status was identified as the main driver of total cost (P [ 0.01 after adjusting for postoperative DSA status). ■ CONCLUSIONS: ICG-VA is a powerful diagnostic tool in demonstrating microsurgical cure of DI-AVFs, with a negative predictive value of 100%. Eliminating post-operative DSA in patients with confirmed DI-AVF obliter-ation on ICG-VA may yield substantial cost savings, in addition to sparing patients the risk and inconvenience of a potentially unnecessary invasive procedure.
