Elsevier

World Neurosurgery

Volume 106, October 2017, Pages 446-449
World Neurosurgery

Technical Note
Transdural Indocyanine Green Videography for Superficial Temporal Artery–to–Middle Cerebral Artery Bypass—Technical Note

https://doi.org/10.1016/j.wneu.2017.07.004Get rights and content

Background

Neurosurgical application of indocyanine green (ICG) videography before performing a dural opening, known as transdural ICG videography, has been used during surgery of meningiomas associated with venous sinuses as well as cranial and spinal arteriovenous malformations. However, its use for a superficial temporal artery (STA)–to–middle cerebral artery (MCA) bypass has not been reported.

Methods

We performed a retrospective analysis of medical records of patients who underwent transdural ICG videography during STA-MCA bypass performed between January 2012 and March 2015. The primary outcome was visualization of recipient cortical arteries; secondary outcomes were surgical modifications and complications as well as any adverse events associated with transdural ICG videography.

Results

We analyzed 29 STA-MCA bypass procedures performed in 30 hemispheres with atherosclerotic steno-occlusive disease and found that the proper recipient was identified in 28 hemispheres. Subsequently modified procedures for those were a tailored dural incision and craniotomy correction. No complications associated with ICG administration were encountered; during the postoperative course, transient aphasia was noted in 1 case, chronic subdural hematoma was noted in 1 case, and subdural effusion was noted in 2 cases.

Conclusions

Transdural ICG videography for atherosclerotic steno-occlusive disease facilitates modifications during STA-MCA bypass procedures. Recognition of the proper recipient cortical arteries before a dural incision allows the neurosurgeon to perform a tailored dural incision and extension of the bone window, although the contribution to surgical outcome has yet to be determined.

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.

Section snippets

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.

References (10)

  • J. Woitzik et al.

    Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography

    J Neurosurg

    (2005)
  • T. Ueba et al.

    Transdural imaging of meningiomas by indocyanine green videography: the eclipse sign

    J Neurol Surg A Cent Eur Neurosurg

    (2013)
  • E. d'Avella et al.

    Indocyanine green videoangiography (ICGV)-guided surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS)

    Acta Neurochir (Wien)

    (2013)
  • T. Ueba et al.

    Identification of venous sinus, tumor location, and pial supply during meningioma surgery by transdural indocyanine green videography

    J Neurosurg

    (2013)
  • A. Della Puppa et al.

    Transdural indocyanine green video-angiography of vascular malformations

    Acta Neurochir (Wien)

    (2014)
There are more references available in the full text version of this article.

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