Technical NoteTransdural Indocyanine Green Videography for Superficial Temporal Artery–to–Middle Cerebral Artery Bypass—Technical Note
Introduction
Indocyanine green (ICG) videography has become an important multimodal technique and is commonly used to confirm bypass patency during neurosurgical procedures.1 Furthermore, the usefulness of transdural observation of the venous sinuses in meningioma cases before dural opening using ICG videography, known as transdural ICG videography, has been reported.2 We present our experience with transdural ICG videography for cases of superficial temporal artery (STA)–to–middle cerebral artery (MCA) bypass used to observe the recipient cortical arteries before opening the dura mater. Benefits, limitations, and other potential uses are discussed.
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Materials and Methods
Between January 2012 and March 2015, 44 STA-MCA bypass procedures were performed at the Department of Neurosurgery of Osaka Police Hospital, Osaka, Japan. After reviewing medical charts and operative records, we included 30 transdural ICG videography procedures performed in 29 patients for this study. Identification of the proper recipient artery, subsequent modification of the procedure, difficulties, and complications were assessed based on findings of retrospective evaluations of the
Results
We retrospectively analyzed 30 procedures performed in 29 patients who underwent transdural ICG videography. Mean patient age was 66 years (range, 36–84 years), and the male-to-female ratio was 2.6:1. A total of 29 STA-MCA bypass procedures performed in 30 hemispheres were identified, including 1 bilateral STA-MCA bypass and 2 cases with unilateral double-barrel anastomosis. An atherosclerotic steno-occlusive lesion of the intracranial internal carotid artery or MCA was found in 28 cases,
Representative Case
A 65-year-old man had a minor ischemic stroke and underwent STA-MCA bypass for atherosclerotic cerebrovascular insufficiency secondary to right intracranial internal carotid artery stenosis. Following a craniotomy (Figure 3A), the infrasylvian M4 segment of the middle cerebral artery was confirmed by intravenous administration of 7.5 mg of ICG before dural opening (Figure 3B). A T-shaped dural opening revealed the recipient cortical artery, to which the STA was anastomosed, then bypass patency
Discussion
Use of transdural ICG videography has been reported in cases of surgery for a meningioma adjacent to the venous sinuses.2, 3, 4 This technique allows the neurosurgeon to recognize the anatomic relationship of the tumor and venous sinuses before dural opening and thus can assist with performance of a subsequent safe dural opening. Previous studies have demonstrated its usefulness in cases of vascular malformations, including arteriovenous malformations, dural arteriovenous fistulas, spinal
Conclusions
Use of transdural ICG videography for STA-MCA bypass allows the neurosurgeon to recognize the recipient cortical arteries before performing a dural incision, which allows modifications as needed, such as a tailored dural incision or extension of the bone window. The contribution of transdural ICG videography to surgical outcome has yet to be determined, although some benefits related to STA-MCA bypass procedures are suggested.
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