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Ni H, Wu Y, Zhou C, Li X, Zhou S, Lan W, Zhang Z, Huang Y, Wang H, Lin J. Application of intraarterial superselective indocyanine green angiography in bypass surgery for adult moyamoya disease. Front Neurol 2023; 14:1241760. [PMID: 37909032 PMCID: PMC10613996 DOI: 10.3389/fneur.2023.1241760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023] Open
Abstract
Background Extracranial-intracranial (EC-IC) bypass surgery is the main treatment approach to moyamoya disease, and an accurate assessment of the patency of anastomosis is critical for successful surgery. So far, the most common way to do this is the intraoperative intravenous indocyanine green (ICG) video-angiography. Intra-arterial ICG-VA has been applied to treat peripheral cerebral aneurysms, spinal arteriovenous fistulas, and dural arteriovenous fistulas, but few reports have concerned the use of arterial injection of ICG to evaluate anastomotic patency. This research aims to explore the feasibility and effects of catheter-guided superficial temporal artery injection of ICG in the evaluation of anastomotic patency after bypass surgery. Methods In this study, 20 patients with moyamoya disease or syndrome who underwent bypass surgery were divided into two groups, one who received intravenous ICG angiography and the other who received intra-arterial ICG angiography, to compare the two injection methods for vascular anastomosis patency. We conducted conventional intraoperative digital subtraction angiography (DSA) in a hybrid operating room during extracranial-intracranial (EC-IC) bypass surgery, including the additional step of injecting ICG into the main trunk of the superficial temporal artery (STA) through a catheter. Results Intra-arterial injection of indocyanine green video-angiography (ICG-VA) indicated good patency of the vascular anastomosis when compared with conventional digital subtraction angiography (DSA) and intravenous ICG-VA, confirming the feasibility of using the arterial injection of ICG for assessing anastomotic patency. And intra-arterial ICG-VA results in faster visualization than intravenous ICG-VA (p < 0.05). Besides, ICG-VA through arterial injection provided valuable information on the vascular blood flow direction after the bypass surgery, and allowed for visual inspection of the range of cortical brain supply from the superficial temporal artery and venous return from the cortex. Moreover, arterial injection of ICG offered a rapid dye washout effect, reducing the repeat imaging time. Conclusion This study indicates that intra-arterial ICG-VA has good effects in observing the direction of blood flow in blood vessels and the range of cortical brain supply from the STA, which reflects blood flow near the anastomosis and provides additional information that may allow the postoperative prediction of cerebral hyperperfusion syndrome. However, the procedure of intra-arterial ICG-VA is relatively complicated compared to intravenous ICG-VA.
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Affiliation(s)
- Haojin Ni
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yiwen Wu
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Chenhui Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xianru Li
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Shengjun Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Wenting Lan
- Department of Radiology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zhimeng Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yi Huang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Haifeng Wang
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Jinghui Lin
- Department of Neurosurgery, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Lin J, Wu Y, Deng X, Zhou S, Liu Y, Zhang J, Zeng Y, Li X, Gao X, Xu B, Zhou C. Application of intraoperative infrared thermography in bypass surgery for adult moyamoya syndrome: A preliminary study. Front Neurol 2023; 14:1174072. [PMID: 37064202 PMCID: PMC10098335 DOI: 10.3389/fneur.2023.1174072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023] Open
Abstract
Background and objectivesCerebral revascularization surgery is the mainstay of treatment for moyamoya syndrome (MMS) today, and intraoperative determination of the patency of the revascularized vessel is a critical factor in the success of the procedure. Currently, major imaging modalities include intraoperative indocyanine green (ICG) videoangiography (ICG-VA), digital subtraction angiography (DSA), and vascular ultrasound Doppler. Infrared thermography is a modern imaging modality with non-contact devices for the acquisition and analysis of thermal data. We aimed to investigate the feasibility and advantages of infrared thermography in determining anastomotic patency during MMS surgery.MethodsIndocyanine green videoangiography and infrared thermography were performed simultaneously in 21 patients with MMS who underwent bypass surgery. The detection result of vessel patency was compared, and the feasibility and advantages of infrared thermography were assessed.ResultsThe patency of the anastomosis was accurately determined in 21 patients using either ICG angiography or infrared thermography. In 20 patients, the results of infrared thermography showed that the vascular anastomosis was unobstructed, and there was an agreement with the subsequent results of ICG-VA. In one patient, we suspected inadequate patency after testing the anastomosis with infrared thermography, and the results of ICG-VA evaluation of the anastomosis confirmed that there was indeed an anastomotic obstruction.ConclusionCompared with ICG-VA, infrared thermography might offer an alternative non-invasive, contrast-free option in assessing anastomosis patency compared with ICG-VA, and it is likely to become more widely used in the clinic in the near future.
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Affiliation(s)
- Jinghui Lin
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yiwen Wu
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xinpeng Deng
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Shengjun Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yuchun Liu
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Junjun Zhang
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Yiyong Zeng
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xianru Li
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Xiang Gao
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
- Xiang Gao,
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
- Bin Xu,
| | - Chenhui Zhou
- Department of Neurosurgery, Ningbo First Hospital, Ningbo University, Ningbo, Zhejiang, China
- *Correspondence: Chenhui Zhou,
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Color Doppler ultrasonography for predicting the patency of anastomosis after superficial temporal to middle cerebral artery bypass surgery. Acta Neurochir (Wien) 2021; 163:1503-1513. [PMID: 33404878 DOI: 10.1007/s00701-020-04669-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Color Doppler ultrasonography (CDUS) is used to evaluate the surgical success and postoperative hemodynamic changes of patients who receive superficial temporal to middle cerebral artery (STA-MCA) bypass surgery. Previous studies enrolled small populations, and difficulties interpreting the results have limited their use in clinical settings. OBJECTIVE We attempted to determine the feasibility of using CDUS to evaluate STA hemodynamics and identify the most reliable parameter as a new clinical implication for determining bypass patency. METHOD Twenty-six patients who underwent STA-MCA bypass surgery were prospectively enrolled. Four times CDUS and two times digital subtraction angiography (DSA) were performed. The CDUS parameters were compensated using the ratio of the operated to the non-operated sides (R1) and compared before and after surgery (R2). The CDUS parameters are then compared with the patency on DSA by statistical analyses. RESULTS Increased CDUS parameters of the mean flow rate (MFR) and cross-sectional diameter (CSD) showed significant correlations with good patency on DSA. The R2 at 1 month was identified as the most reliable parameter for predicting the patency in both MFR and CSD. Their cutoff values were 1.475 and 1.15, respectively. CONCLUSION CDUS can be utilized for predicting the patency after STA-MCA bypass surgery; if the postoperative (compensated and compared) CDUS parameters increased by more than 47.5% in the MFR or 15% in the CSD, the patency of the anastomosis on DSA would be good.
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Wanebo JE, Amin-Hanjani S, Boyd C, Peery T. Assessing success after cerebral revascularization for ischemia. Skull Base 2005; 15:215-27. [PMID: 16175231 PMCID: PMC1214707 DOI: 10.1055/s-2005-872597] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cerebral revascularization continues to evolve as an option in the setting of ischemia. The potential to favorably influence stroke risk and the natural history of cerebrovascular occlusive disease is being evaluated by the ongoing Carotid Occlusion Surgery Study and the Japanese Extracranial-Intracranial Bypass Trial. For those patients who undergo bypass in the setting of ischemia, four key areas of follow-up include functional neurological status, neurocognitive status, bypass patency, and status of cerebral blood flow and perfusion. Several stroke scales that can be used to assess functional status include the National Institutes of Health Stroke Scale, Bathel Index, Modified Rankin Scale, and Stroke Specific Quality of Life. Neurocognition can be checked using the Repeatable Battery for the Assessment of Neuropsychological Status, among other tests. Bypass patency is checked intraoperatively using various flow probes and postoperatively using magnetic resonance angiography (MRA) or computed tomographic angiography (CTA). Cerebral blood flow and perfusion can be assessed using a host of modalities that include positron emission tomography (PET), xenon CT, single photon emission computed tomography (SPECT), transcranial Doppler (TCD), CT, and MR. Paired blood flow studies after a cerebral vasodilatory stimulus using one of these modalities can determine the state of autoregulatory vasodilation (Stage 1 hemodynamic compromise). However, only PET with oxygen extraction fraction measurements can reliably assess for Stage 2 compromise (misery perfusion). This article discusses the various clinical, neuropsychological, and radiographic techniques available to assess a patient's clinical state and cerebral blood flow before and after cerebral revascularization.
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Affiliation(s)
- John E Wanebo
- Department of Neurosciences, Division of Neurosurgery, Naval Medical Center San Diego, San Diego, California 92134-3201, USA.
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