The Role of Combined Use of Indocyanine Green and Sodium Fluorescein in AVM Surgery

I read with interest the article by Özgen and Kırış evaluating the combined intraoperative use of indocyanine green (ICG) and sodium fluorescein in arteriovenous malformation (AVM) surgery. The study addresses a clinically relevant technical question in vascular neurosurgery and highlights the complementary strengths of these fluorescence-based modalities during microsurgical resection. The reported complete obliteration rate and absence of dye-related complications are encouraging. However, several points should be considered when interpreting the findings. The cohort is small and includes both intracranial and one cervical spinal AVM, which may limit generalizability. In addition, because the study does not compare the dual approach with ICG alone, sodium fluorescein alone, or intraoperative digital subtraction angiography, the specific incremental value of the combined strategy remains uncertain. Overall, the article provides useful operative insight and supports further comparative research in larger, more homogeneous cohorts.