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Di Bonaventura R, Brunasso L, Sturiale CL, Valente I, Pedicelli A, Marchese E, Maugeri R, Iacopino DG, Olivi A, Albanese A. Preoperative angiographic protocol for the surgical management of spinal dural arteriovenous fistulas: a technical nuance for safe minimally invasive surgery. World Neurosurg 2024:S1878-8750(24)00723-X. [PMID: 38692568 DOI: 10.1016/j.wneu.2024.04.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Interruption of the fistoulus point is the goal of the treatment of spinal dural arteriovenous fistula (dAVFs). Microsurgery still represents a highly efficient treatment in terms of complete occlusion with the lowest risk of recurrence rate. It is reported that the hardest step consists in finding the fistulous site itself, potentially extending surgical access and time, and increasing potential post-operative surgical-related complications. The accurate preoperative detection of the shunt and spinal level together is crucial for guiding optimal, fast and safe microsurgical treatment. METHODS In the present paper, the authors describe a preoperative angiographic protocol for achieving a safe and simple resection of spinal dAVFs based on a six-year Institutional experience of forty-two patients who underwent minimally invasive. Two illustrative cases are also included in order to support the technical descriptions. RESULTS The suspected artery associated to the vascular malformation of interest is studied in our angiographic protocol through non-subtracted selective acquisitions in the lateral projection. The resulting frames are reconstructed with 3D Rotational Angiography. The implementation of the preoperative angiographic protocol allowed 100% of intraoperative identification of the fistoulus point in all cases with the use of minimally invasive approach. CONCLUSIONS Nowadays, neurosurgeons advocate for minimally invasive procedures and low morbidity risk procedures for the treatment of spinal dAVFs.Our preoperative approach for accurate angigoraphic localization of the fistoulus point through non-subtracted and 3D reconstructed angiography allowed to achieve safe and definitive occlusion of the shunt.
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Affiliation(s)
- Rina Di Bonaventura
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Lara Brunasso
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy.
| | - Carmelo Lucio Sturiale
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Iacopo Valente
- Department of Diagnostic Imaging, Unit of Interventional Neuro-Radiology, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Alessandro Pedicelli
- Department of Diagnostic Imaging, Unit of Interventional Neuro-Radiology, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - Enrico Marchese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Rosario Maugeri
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Domenico Gerardo Iacopino
- Neurosurgical Clinic, AOUP "Paolo Giaccone", Post Graduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, University of Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessio Albanese
- Department of Neurosurgery, Fondazione Policlinico Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Institute of Neurosurgery, Catholic University of the Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
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Kato N, Kan I, Abe Y, Otani K, Narikiyo M, Nagayama G, Nishimura K, Mori R, Kodama T, Ishibashi T, Murayama Y. Visualization of extracranial-intracranial bypass in moyamoya patients using intraoperative three-dimensional digital subtraction angiography with intravenous contrast injection and robotic C-arm: patient series. J Neurosurg Case Lessons 2021; 1:CASE2057. [PMID: 36131586 PMCID: PMC9628098 DOI: 10.3171/case2057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/19/2020] [Indexed: 06/15/2023]
Abstract
BACKGROUND The authors describe a noninvasive intraoperative imaging strategy of three-dimensional (3D) digital subtraction angiography (DSA) with intravenous (IV) contrast injection, using indocyanine green (ICG) as a test bolus, during extracranial-intracranial (EC-IC) bypass surgery for moyamoya disease. OBSERVATIONS Four patients underwent EC-IC bypass surgery in a hybrid operating room. During the surgery, bypass patency was verified using ICG videoangiography and Doppler ultrasonography. After skin closure, the patients under anesthesia underwent IV 3D-DSA with a robotic C-arm in which the scan delay time for the 3D-DSA scan was estimated from the arrival time of ICG during the ICG videoangiography. One day after the surgery, the patients underwent magnetic resonance angiography (MRA). The IV 3D-DSA images were retrospectively compared with those obtained with other modalities. Good bypass patency was confirmed on IV 3D-DSA, ICG videoangiography, Doppler ultrasonography, and postoperative MRA in all cases. The delay time determined using ICG videoangiography as a test bolus resulted in IV 3D-DSA with adequate image quality, allowing assessment of the spatial relationships between the vessels and anastomoses from all directions. LESSONS To evaluate bypass patency and anatomical relationships immediately after EC-IC bypass surgery, IV 3D-DSA may be a useful modality. ICG videoangiography can be used to determine the scan delay time.
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Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Issei Kan
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yukiko Abe
- Department of Radiology, The Jikei University Hospital, Tokyo, Japan
| | - Katharina Otani
- Siemens Healthcare K.K., Advanced Therapies Innovation Department, Tokyo, Japan; and
| | - Michihisa Narikiyo
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
- Department of Neurosurgery, Kawasaki Saiwai Hospital, Kanagawa, Japan
| | - Gota Nagayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Kengo Nishimura
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Ryosuke Mori
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Tomonobu Kodama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Toshihiro Ishibashi
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Yuichi Murayama
- Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
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Goldberg J, Vajkoczy P, Hecht N. Indocyanine green videoangiography for recipient vessel stratification in superficial temporal artery-middle cerebral artery bypass surgery. J Neurosurg 2020:1-9. [PMID: 32858511 DOI: 10.3171/2020.5.jns20642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery, recipient vessel properties are likely one of the main reasons for bypass failure. In daily practice, most surgeons select the recipient with the largest diameter. However, selection of the ideal recipient remains debatable because there are no objective selection criteria if multiple potential recipients exist. Here, the authors assessed the benefit of using indocyanine green videoangiography (ICG-VA) to optimize recipient vessel selection in patients undergoing STA-MCA bypass surgery for hemodynamic compromise. METHODS All patients who had undergone STA-MCA bypass procedures with pre- and postanastomosis ICG-VA between 2010 and 2019 were eligible for inclusion in this study. The primary bypass surgeon was blinded to the preanastomosis ICG-VA. Preanastomosis white-light and ICG-VA images were compared to determine the identifiability of potential recipient vessels and pathological flow patterns. After completion of the anastomosis, a second (postanastomosis) ICG-VA image was used to analyze the flow increase within the chosen recipient based on the vessel diameter, initial recipient blood flow, initial sequence of appearance on ICG-VA, initial blood flow direction within the recipient, and orientation of the bypass graft. ICG-VA, FLOW 800, and intraoperative white-light images, as well as demographic, clinical, and radiographic patient data, were retrospectively analyzed by a clinician who was not directly involved in the patients' care. RESULTS Sixty patients underwent 65 STA-MCA bypass procedures with pre- and postanastomosis ICG-VA. The ICG-VA permitted identification of a significantly higher number of potential recipient vessels (median 4, range 1-9) than the white-light images (median 2, range 1-5; p < 0.001), with detection of pathological flow patterns in 20% of all procedures. No association was found between the diameter and blood flow within potential recipients (Spearman r = 0.07, p = 0.69). After bypass grafting, the highest flow increase was noted in recipients with an initially low flow (p < 0.01), a late appearance (p < 0.01), and an initially retrograde flow direction (p = 0.02). Interestingly, flow increase was not significantly influenced by the recipient diameter (p = 0.09) or graft orientation (p = 0.44). CONCLUSIONS ICG-VA facilitates identification of potential recipient vessels and detection of pathological flow patterns. Recipients with an initially low flow, a late appearance, and a retrograde flow seem to bear the highest potential for flow increase, possibly due to a higher hemodynamic need for revascularization.
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Affiliation(s)
- Johannes Goldberg
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Germany; and.,2Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter Vajkoczy
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Germany; and
| | - Nils Hecht
- 1Department of Neurosurgery and Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Germany; and
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Cavallo C, Gandhi S, Zhao X, Belykh E, Valli D, Nakaji P, Preul MC, Lawton MT. Applications of Microscope-Integrated Indocyanine Green Videoangiography in Cerebral Revascularization Procedures. Front Surg 2019; 6:59. [PMID: 31850362 PMCID: PMC6902023 DOI: 10.3389/fsurg.2019.00059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/02/2019] [Indexed: 11/13/2022] Open
Abstract
Indocyanine green videoangiography (ICG-VA) is a near-infrared range fluorescent marker used for intraoperative real-time assessment of flow in cerebrovascular surgery. Given its high spatial and temporal resolution, ICG-VA has been widely established as a useful technique to perform a qualitative analysis of the graft patency during revascularization procedures. In addition, this fluorescent modality can also provide valuable qualitative and quantitative information regarding the cerebral blood flow within the bypass graft and in the territories supplied. Digital subtraction angiography (DSA) is considered to be the gold standard diagnostic modality for postoperative bypass graft patency assessment. However, this technique is time and labor intensive and an expensive interventional procedure. In contrast, ICG-VA can be performed intraoperatively with no significant addition to the total operative time and, when used correctly, can accurately show acute occlusion. Such time-sensitive ischemic injury detection is critical for flow reestablishment through direct surgical management. In addition, ICG has an excellent safety profile, with few adverse events reported in the literature. This review outlines the chemical behavior, technical aspects, and clinical implications of this tool as an intraoperative adjunct in revascularization procedures.
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Affiliation(s)
- Claudio Cavallo
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Sirin Gandhi
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Xiaochun Zhao
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Evgenii Belykh
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Daniel Valli
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Peter Nakaji
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Mark C Preul
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
| | - Michael T Lawton
- Department of Neurosurgery, St. Joseph's Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, United States
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Gioppo A, Acerbi F, Faragò G. Detection and treatment of a spinal dural arteriovenous fistula supplied by a radiculomedullopial artery: case illustration. J Neurosurg Spine 2019; 32:1-2. [PMID: 31756703 DOI: 10.3171/2019.9.spine19946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/13/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Francesco Acerbi
- 2Vascular Neurosurgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Kim JH, Moon KS, Jung JH, Jang WY, Jung TY, Kim IY, Lee KH, Jung S. Importance of collateral venous circulation on indocyanine green videoangiography in intracranial meningioma resection: direct evidence for venous compression theory in peritumoral edema formation. J Neurosurg 2019; 132:1715-1723. [PMID: 31125964 DOI: 10.3171/2019.3.jns182308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 03/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Indocyanine green videoangiography (ICGVA) has been used in many neurosurgical operations, including vascular and brain tumor fields. In this study, the authors applied ICGVA to intracranial meningioma surgery and evaluated it usefulness with attention to collateral venous flow. METHODS Forty-two patients with intracranial meningioma who underwent ICGVA during microsurgical resection were retrospectively analyzed. For ICGVA, the ICG was injected intravenously at the standard dose of 12.5 mg before and/or after tumor resection. Intravascular fluorescence from blood vessels was imaged through a microscope with a special filter and infrared excitation light to illuminate the operating field. The authors assessed the benefits of ICGVA and analyzed its findings with preoperative radiological findings on MRI. RESULTS ICGVA allowed real-time assessment of the patency and flow direction in very small peritumoral vessels in all cases. A safe dural incision could also be done based on information from ICGVA. The collateral venous channel due to venous obstruction of tumoral compression was found in 10 cases, and venous flow restoration after tumor resection was observed promptly after tumor resection in 4 cases. Peritumoral brain edema (PTBE) was observed on preoperative T2-weighted MRI in 19 patients. The presence of collateral venous circulation or flow restoration was significantly related to PTBE formation in multivariate analysis (p = 0.001; HR 0.027, 95% CI 0.003-0.242). CONCLUSIONS ICGVA, an excellent method for monitoring blood flow during meningioma resection, provides valuable information as to the presence of venous collaterals and flow restoration. Furthermore, the fact that the presence of venous collaterals was found to be associated with PTBE may directly support the venous theory as the pathogenesis of PTBE formation.
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Affiliation(s)
| | | | | | | | | | | | - Kyung-Hwa Lee
- 2Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
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Fischer G, Rediker J, Oertel J. Endoscope- versus microscope-integrated near-infrared indocyanine green videoangiography in aneurysm surgery. J Neurosurg 2018; 131:1-10. [PMID: 30485185 DOI: 10.3171/2018.4.jns172650] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/23/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE: The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving blood flow in the parent, branching, and perforating arteries. For a few years, there has been a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: microscope-integrated indocyanine green videoangiography (mICG-VA). This method allows for real-time information about blood flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field, especially through small craniotomies. To compensate for these drawbacks, an endoscope-integrated ICG-VA (eICG-VA) was developed. The objective of the present study was to assess the use of eICG-VA in comparison with mICG-VA for intraoperative blood flow evaluation. METHODS: In the period between January 2011 and January 2015, 216 patients with a total of 248 intracranial saccular aneurysms were surgically treated in the Department of Neurosurgery of Saarland University Medical Center in Homburg/Saar, Germany. During 95 surgeries in 88 patients with a total of 108 aneurysms, intraoperative evaluation was performed with both eICG-VA and mICG-VA. After clipping, evaluation of complete aneurysm occlusion and flow in the parent, branching, and perforating arteries was performed using both methods. Intraoperative applicability of each technique was compared with the other and with postoperative digital subtraction angiography as a standard evaluation technique. RESULTS: Evaluation of completeness of aneurysm occlusion and of flow in the parent, branching, and perforating arteries was more successful with eICG-VA than with mICG-VA, especially for aneurysm neck assessment (88.9% vs 69.4%). For 63.9% of the aneurysms (n = 69), both methods were equivalent, but in 30.6% of the cases (n = 33), the eICG-VA provided better results for evaluating the post-clipping situation. In 4.6% of these aneurysms (n = 5), the information given by the additional endoscope considerably changed the surgical procedure. Thus, one residual aneurysm (0.9%), two neck remnants (1.9%), and two branch occlusions (1.9%) could be prevented. Nevertheless, two incomplete aneurysm occlusions (1.9%) and six neck remnants (5.6%) were revealed by postoperative digital subtraction angiography. CONCLUSIONS: Endoscope-integrated ICG-VA seems to be an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers higher illumination, magnification, and an extended viewing angle. Its main advantage is its ability to assess deep-seated aneurysms, especially through small craniotomies, but further studies are required.
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Abstract
Subcortical arteriovenous malformations (AVMs) are surgically challenging. Localization is crucial for eloquent areas, and complete resection evaluation is uncertain. Indocyanine green videoangiography (ICG-VA) can assist this surgery. An illustrative video of a subcortical frontoparietal bleeding AVM resection assisted by ICG-VA is presented. A bleeding arterial feeder aneurysm was embolized in the acute phase to protect against rebleeding. ICG-VA helped to detect the AVM's superficial arterialized draining vein, distinguishing it from normal cortical veins. This enabled a customized sulcus approach. ICG-VA showed normalized flow through the previously arterialized vein, confirming the AVM's complete resection. This applies when there is a single drainage remaining. The video can be found here: https://youtu.be/L7yJEE66kV0 .
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Affiliation(s)
- Oriela Rustemi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Renato Scienza
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
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Zaimoku M, Kawaguchi Y, Seki S, Yahara Y, Akioka N, Imura J, Kimura T, Kuroda S. Sporadic hemangioblastoma of the film terminale with peritumoral cyst. Surg Neurol Int 2018; 9:2. [PMID: 29399374 PMCID: PMC5778725 DOI: 10.4103/sni.sni_221_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022] Open
Abstract
Background: Spinal hemangioblastoma originating from the film terminale are rare tumors. Here, we present a film terminale hemangioblastoma and review the appropriate literature. Case Description: A 37-year-old female presented with bilateral lower extremity pain without a focal neurological deficit. The magnetic resonance (MR) image demonstrated an intradural spinal tumor at the L1 level, which was accompanied by peritumoral cysts. In addition, there were multiple surpentine flow voids (e.g., consistent with torturous and convoluted vessels), which is typical for hemangioblastoma. At surgery, a spinal hemangioblastoma originating from the film terminale with peritumoral cysts at the L1 level was fully excised without producing a focal postoperative neurological deficit. Histological examination revealed stromal cells with vacuolated cytoplasm and small nuclei in a rich capillary network accompanied by several enlarged vessels. These finding were compatible with a hemangioblastoma. Conclusions: We reported a rare case of a hemangioblastoma originating from the conus presenting at the L1 level. Complete surgical resection was accomplished without any motor deficit.
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Affiliation(s)
- Miho Zaimoku
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
| | | | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
| | - Yasuhito Yahara
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
| | - Naoki Akioka
- Department of Neurosurgery, University of Toyama, Toyama, Japan
| | - Johji Imura
- Department of Diagnostic Pathology, University of Toyama, Toyama, Japan
| | - Tomoatsu Kimura
- Department of Orthopaedic Surgery, University of Toyama, Toyama, Japan
| | - Satoshi Kuroda
- Department of Neurosurgery, University of Toyama, Toyama, Japan
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Kumar V, Jagetia A, Singh D, Srivastava AK, Tandon MS. Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography. J Neurosci Rural Pract 2017; 8:342-345. [PMID: 28694610 PMCID: PMC5488551 DOI: 10.4103/jnrp.jnrp_1_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms. Materials and Methods: A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients. Postoperative DSA was performed to assess the efficacy of ICG-VA. Results: Intraoperative ICG-VA revealed the occlusion of aneurysm in all the thirty patients. Postoperative DSA revealed aneurysm neck remnant in two patients and demonstrated no branch occlusion. Conclusions: Intraoperative ICG-VA is useful in assessing the completeness of clipping of cerebral aneurysms and ensures patency of branch vessels, thus providing a better postoperative outcome. It replaces the need for invasive postoperative angiographic imaging in a selected group of patients and is also cost effective.
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Affiliation(s)
- Vikas Kumar
- Department of Neurosurgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Anita Jagetia
- Department of Neurosurgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Arvind Kumar Srivastava
- Department of Neurosurgery, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Monica Sehgal Tandon
- Department of Anaesthesiology, G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Yang T, Higashino Y, Kataoka H, Hamano E, Maruyama D, Iihara K, Takahashi JC. Correlation between reduction in microvascular transit time after superficial temporal artery-middle cerebral artery bypass surgery for moyamoya disease and the development of postoperative hyperperfusion syndrome. J Neurosurg 2017; 128:1304-1310. [PMID: 28498060 DOI: 10.3171/2016.11.jns162403] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hyperperfusion syndrome (HPS) is a notable complication that causes various neurological symptoms after superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery for moyamoya disease (MMD). The authors used intraoperative indocyanine green (ICG) videoangiography to measure the change in microvascular transit time (MVTT) after bypass surgery. An analysis was then conducted to identify the correlation between change in MVTT and presence of postoperative HPS. METHODS This study included 105 hemispheres of 81 patients with MMD who underwent STA-MCA single bypass surgery between January 2010 and January 2015. Intraoperative ICG videoangiography was performed before and after bypass surgery. The MVTT was calculated from the ICG time intensity curve recorded in the pial arterioles and venules. Multivariate logistic regression analysis was conducted to test the effect of multiple variables, including the change in MVTT after bypass surgery, on postoperative HPS. RESULTS Postoperative HPS developed in 28 (26.7%) of the 105 hemispheres operated on. MVTT was reduced significantly after bypass surgery (prebypass 5.34 ± 2.00 sec vs postbypass 4.12 ± 1.60 sec; p < 0.001). The difference between prebypass and postbypass MVTT values, defined as ΔMVTT, was significantly greater in the HPS group than in the non-HPS group (2.55 ± 2.66 sec vs 0.75 ± 1.78 sec; p < 0.001). Receiver operating characteristic curve analysis revealed that the optimal cutoff point of ΔMVTT was 2.6 seconds (sensitivity 46.4% and specificity 85.7% as a predictor of postoperative HPS). A ΔMVTT > 2.6 seconds was an independent predictor of HPS in multivariate analysis (hazard ratio 4.88, 95% CI 1.76-13.57; p = 0.002). CONCLUSIONS MVTT in patients with MMD was reduced significantly after bypass surgery. Patients with a ΔMVTT > 2.6 seconds tended to develop postoperative HPS. Because ΔMVTT can be easily measured during surgery, it is a useful diagnostic tool for identifying patients at high risk for HPS after STA-MCA bypass surgery for MMD.
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Affiliation(s)
- Tao Yang
- 1Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Yoshifumi Higashino
- 2Department of Neurosurgery, University of Fukui Faculty of Medical Sciences, Fukui; and
| | - Hiroharu Kataoka
- 1Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Eika Hamano
- 1Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Daisuke Maruyama
- 1Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
| | - Koji Iihara
- 3Department of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun C Takahashi
- 1Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka
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Kato Y, Yamada Y, Sadato A, Nouri M, Cherian I, Tanaka T, Inamasu J. Intraoperative Anatomical and Hemodynamic Analysis of Intracerebral Arteriovenous Malformations by Semi-quantitative Color-coded Indocyanine Green Videoangiography. Asian J Neurosurg 2017; 12:638-643. [PMID: 29114275 PMCID: PMC5652087 DOI: 10.4103/ajns.ajns_62_14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective and Background: To evaluate possible roles for indocyanine green (ICG)-based FLOW 800 software in surgical treatment of cerebral arteriovenous malformations (AVMs). Methods: We perform ICG videoangiography several times for each step of AVM resection to elucidate feeders, drainers, and cerebral perfusion. Results: Since 2010, 22 AVM surgeries in our department have been conducted using FLOW 800 intraoperatively. We demonstrated ICG angiograms, color-coded images, and semi-quantitative curves for AVMs. By reviewing all these modalities, we would define vascular structure of the AVM, proceed with resection, and finally recheck for any remnant. Conclusions: ICG FLOW 800 software helps the surgeon to recognize feeding and draining vessels of an AVM intraoperatively. Further studies to evaluate semi-quantitative acquired data regarding blood flow and tissue perfusion are warranted.
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Affiliation(s)
- Yoko Kato
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Akiyo Sadato
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Mohsen Nouri
- Gundishapour Academy of Neuroscience, Ahvaz, Iran
| | - Iype Cherian
- Institute of Neurosciences, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal
| | - Teppei Tanaka
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Joji Inamasu
- Department of Neurosurgery, Fujita Health University, Toyoake, Aichi, Japan
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Kubota H, Sanada Y, Nagatsuka K, Yoshioka H, Iwakura M, Kato A. Safe and accurate sylvian dissection with the use of indocyanine green videoangiography. Surg Neurol Int 2016; 7:S427-9. [PMID: 27313972 PMCID: PMC4901820 DOI: 10.4103/2152-7806.183526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background: Sylvian dissection is an essential microneurosurgical skill for neurosurgeons. The safe and accurate opening of the sylvian fissure is desirable for a good prognosis. Methods: The aim of this report is to demonstrate the use of indocyanine green (ICG) videoangiography to recognize the superficial sylvian vein (SSV) and thus enable a wide opening of the sylvian fissure, especially in patients with subarachnoid hemorrhage (SAH). Results: The small tributary flowing into the SSV was distinguishable from a passing one, which deeply entered the insula. In addition, an entering point of a tributary to the SSV, which ran perpendicular to the insula, was occasionally determined. SSV, which was barely discernable in a reddish SAH involving the sylvian fissure, was clearly demarcated using ICG videoangiography. Two representative cases of sylvian dissection are herein presented. Conclusion: The performance of ICG videoangiography before sylvian dissection is a simple and useful method for identifying a vital approach route for safe and accurate sylvian dissection, and it reduces the risk of causing any accidental injury to the veins in the sylvian fissure.
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Affiliation(s)
- Hisashi Kubota
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yasuhiro Sanada
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Kazuhiro Nagatsuka
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiromasa Yoshioka
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Michihiro Iwakura
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Amami Kato
- Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan
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Avery M, Chehab S, Wong JH, Mitha AP. Intraoperative indocyanine green videoangiography to guide decision making regarding need for vessel bypass: A case report and technical note. Surg Neurol Int 2016; 7:S36-9. [PMID: 26862459 PMCID: PMC4722519 DOI: 10.4103/2152-7806.173567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/14/2015] [Indexed: 11/20/2022] Open
Abstract
Background: Indocyanine green (ICG) videoangiography is an intraoperative technique recently used in vascular neurosurgery to assess the presence or absence of blood flow during critical times of a procedure. These include, but are not limited to, detecting whether daughter branches or perforators are patent after placing a vascular clip or determining whether an aneurysm has been completely isolated from the cerebral circulation after clipping. We present a case of a less-commonly reported application of ICG videoangiography involving the selection of a vessel to act as the bypass recipient once the need is identified during the surgical treatment of a complex intracranial aneurysm. Case Description: A 51-year-old male presented with a ruptured dissecting superior cerebellar artery (SCA) aneurysm that had two branches arising from the dome. Due to the difficult morphology of this aneurysm, a superficial temporal artery to SCA bypass was planned. We used ICG videoangiography to identify the branch that had insufficient retrograde flow via collateral circulation, to which the bypass was performed, followed by the isolation of the aneurysm from the cerebral circulation using permanent surgical clips. Conclusion: Our case represents a possible use of ICG videoangiography during the operative treatment of a difficult aneurysm. Our patient suffered no infarcts postoperatively. In the correct clinical context, this method represents a possible treatment option for complex aneurysms requiring a bypass.
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Affiliation(s)
- Michael Avery
- Division of Neurosurgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Somar Chehab
- Division of Neurosurgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - John H Wong
- Division of Neurosurgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Alim P Mitha
- Division of Neurosurgery, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
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Thind H, Hardesty DA, Zabramski JM, Spetzler RF, Nakaji P. The role of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intracranial dural arteriovenous fistulas. J Neurosurg 2015; 122:876-82. [PMID: 25555024 DOI: 10.3171/2014.11.jns14947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The successful treatment of an intracranial dural arteriovenous fistula (dAVF) requires complete obliteration of blood flow through the fistulous point. Surgical ligation is often used along with endovascular techniques. Digital subtraction angiography (DSA) can be used to confirm fistula obliteration; however, this technique can be cumbersome intraoperatively and difficult to correlate anatomically with the surgical field. Near-infrared indocyanine green (ICG) videoangiography has been described as a complementary tool for this purpose. METHODS The authors examined intracranial dAVF cases in which microscope-integrated intraoperative ICG videoangiography was used to identify and/or confirm obliteration of the dAVF during surgery. Retrospective evaluation of all intracranial dAVF cases treated with surgical ligation over a 10-year period at the Barrow Neurological Institute (n = 47) revealed 28 cases in which ICG videoangiography was used. The results were compared with findings on preoperative and intraoperative or postoperative DSA. RESULTS ICG videoangiography successfully confirmed the fistulous point intraoperatively in 96% (22/23) of the cases. It also revealed complete obliteration of fistulas, comparable to intraoperative or postoperative DSA, in 91% (21/23) of the cases. The false-negative rate of ICG was 8.7% (2/23), which is similar to the false-negative rate of intraoperative DSA alone (10.5% [2/19]). CONCLUSIONS Microscope-based ICG videoangiography provides real-time information about the intraoperative anatomy of dAVFs. In addition, it can confirm complete obliteration of a fistula. This technique may be useful during dAVF surgery as an independent form of angiography or as an adjunct to intraoperative or postoperative DSA.
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Affiliation(s)
- Harjot Thind
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Sugimoto T, Park YS, Nakagawa I, Nishimura F, Motoyama Y, Nakase H. Effectiveness of intraoperative indocyanine green videoangiography in direct surgical treatment of pediatric intracranial pial arteriovenous fistula. J Neurosurg Pediatr 2015; 15:55-9. [PMID: 25343732 DOI: 10.3171/2014.9.peds13683] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracranial pial arteriovenous fistulas (AVFs) are rare cerebrovascular lesions. The authors report a rare case of pediatric pial AVF treated by direct disconnection with the aid of indocyanine green (ICG) videoangiography. A 3-year-old girl presented with developmental problems. Magnetic resonance imaging revealed brain atrophy and an anomalous left temporal vascular mass. Angiography showed a high-flow pial AVF in the early arterial phase fed by the M1 portion of the left middle cerebral artery and draining into the superficial sylvian vein and the vein of Trolard with a large varix. Given that her fistula was located in a superficial region that was easily accessible by craniotomy, the authors successfully disconnected her pial AVF by direct surgery aided by ICG videoangiography, which clearly confirmed the shunting point. In this report, the authors discuss the existing literature and compare the relative merits of endovascular versus surgical options for the treatment of pial AVF.
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Affiliation(s)
- Tadashi Sugimoto
- Department of Neurosurgery, Higashiosaka City General Hospital, Osaka; and
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Gürer B, Antar V, Cikla U, Bauer A, Baskaya MK. Intraoperative dynamic assessment of the posterior communicating artery and its branches by indocyanine green videoangiography. Surg Neurol Int 2013; 4:122. [PMID: 24232934 PMCID: PMC3815034 DOI: 10.4103/2152-7806.118936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/28/2013] [Indexed: 11/23/2022] Open
Abstract
Background: True hemodynamic assessment of the posterior communicating artery (PComA) by preoperative angiography in terms of its perforators and configuration (adult vs. fetal vs. transitional) can be challenging in the surgical treatment of aneurysms involving the PComA, posterior cerebral artery, and basilar artery. Indocyanine green videoangiography (ICG-VA) is a widely accepted new technique in the surgical treatment of intracranial aneurysms to assess the patency of the parent artery, branches, and residual flow within the aneurysm after clipping. Case Description: Here we report two cases in which ICG-VA was utilized to assess either the direction of flow in the PComA or preservation of the PComA perforators with temporary clip application before dividing the PComA. Conclusions: Our experience is that ICG-VA can be used to assess the main trunk, and perforating branches of the PComA providing real-time, dynamic intraoperative information of the surgical field. Therefore we suggest that ICG-VA may increase the safety of surgical treatment of aneurysm involving PComA.
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Affiliation(s)
- Bora Gürer
- Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53792, USA
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Takami T, Yamagata T, Naito K, Arima H, Ohata K. Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography. Surg Neurol Int 2013; 4:135. [PMID: 24232309 PMCID: PMC3815013 DOI: 10.4103/2152-7806.119352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/19/2013] [Indexed: 11/29/2022] Open
Abstract
Background: The authors demonstrate the utility of indocyanine green videoangiography (ICG-VA) for intraoperative vascular flow assessment in the surgery of a variety of spinal intramedullary tumors to achieve an additional level of safety as well as precision with the surgical procedure. Methods: Fourteen patients with spinal intramedullary tumors (nine cervical and five thoracic) operated on between August 2011 and April 2013 were included in the present study. A fluorescence surgical microscope was used to perform ICG-VA after standard exposure of the lesion to assess the dynamic flow of the spinal microvasculature. Results: Twenty-seven ICG-VA injections were performed in 14 cases. Pathological diagnosis of the tumors included ependymoa, astrocytoma, cavernous malformation, or hemagioblastoma. There were no complications or side-effects related to ICG-VA. Intraoperative ICG-VA provided dynamic flow images of the spinal microvasculature in accordance with the progress of surgical procedures. Angiographic images could be divided into arterial, capillary, and venous phases. All angiographic images were well integrated into the microscopic view. The utility of ICG-VA could be summarized into three categories: (1) Localization of normal spinal arteries and veins, (2) assessment of posterior spinal venous circulation, and (3) differentiation of feeding arteries, tumor, and draining veins. Conclusions: Intraoperative vascular flow assessment using ICG-VA was easy, repeatable, and practical without any significant procedure-related risks. ICG-VA can be used for careful analysis of spinal microvascular flow or anatomical orientation, which is necessary to ensure safe and precise resection of spinal intramedullary tumors.
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Affiliation(s)
- Toshihiro Takami
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Trinh VT, Duckworth EA. Surgical excision of filum terminale arteriovenous fistulae after lumbar fusion: Value of indocyanine green and theory on origins (a technical note and report of two cases). Surg Neurol Int 2011; 2:63. [PMID: 21697980 PMCID: PMC3115162 DOI: 10.4103/2152-7806.81065] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/20/2011] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intradural filum terminale arteriovenous fistulas (AVFs) are uncommon. We report two cases of this rare entity in which we used indocyanine green (ICG) videoangiography to identify the fistulous connection of each lesion. CASE DESCRIPTION Two male patients presented with unresolved lower extremity weakness and paresthesias following lumbar fusion surgery. In each case, angiography showed an AVF between the filum terminale artery (FTA), the distal segment of the anterior spinal artery (ASA), and an accompanying vein of the filum terminale. A magnetic resonance image (MRI) obtained before lumbar fusion was available in one of these cases and demonstrated evidence of the preexisting vascular malformation. Surgical obliteration of each fistulous connection was facilitated by the use of ICG videoangiography. This emerging technology was instrumental in pinpointing fistula anatomy and in choosing the exact segment of the filum for disconnection. CONCLUSION Our findings indicate that intradural filum terminale AVFs may have a congenital origin and that ICG is a useful tool in their successful surgical management. As these cases demonstrate, spine surgeons should remain vigilant in evaluating patients based on their clinical symptomatology, even in the presence of obvious lumbar pathology.
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Affiliation(s)
- Victoria T. Trinh
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
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Chen SF, Kato Y, Oda J, Kumar A, Watabe T, Imizu S, Oguri D, Sano H, Hirose Y. The application of intraoperative near-infrared indocyanine green videoangiography and analysis of fluorescence intensity in cerebrovascular surgery. Surg Neurol Int 2011; 2:42. [PMID: 21541008 PMCID: PMC3075608 DOI: 10.4103/2152-7806.78517] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/11/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness and limitations of the intraoperative near-infrared (NIR) indocyanine green videoangiography (ICG-VA) and analysis of fluorescence intensity in cerebrovascular surgery. METHODS Forty-eight patients received ICG-VA during various surgical procedures from May 2010 to August 2010. Included among them were 45 cases of cerebral aneurysms and 3 cases of cerebral arteriovenous malformations (AVMs). The infrared fluorescence module integrated into the surgical microscope was used to visualize fluorescent areas in the surgical field. An integrated analytical visualization tool constantly analyzed the fluorescence video sequence and generated it in the form of an intensity diagram for objective interpretation. RESULTS Overall, the procedure of ICG VA was done 158 times in 48 patients. There was no adverse effect of ICG dye. In cerebral aneurysm cases, the images obtained were of high resolution. In 4 cases, incomplete clipping was detected by ICG-VA and allowed suitable adjustment to completely obliterate the aneurysm. In 3 aneurysm cases, the intensity diagram of ICG VA provided valuable information. ICG-VA identified the feeding arteries, the draining veins, and nidus in all 3 AVM cases, which was confirmed by an immediate analysis of fluorescence intensity. CONCLUSIONS ICG-VA provides high resolution images allowing real-time assessment of the blood flow in surgical field. The intensity analysis function, in addition, is a useful adjunct to improve the accuracy of the clipping and decrease the complication rates in cerebral aneurysm cases. In cerebral AVM cases, with the help of color map and intensity diagram function, the superficial feeders, drainers, and nidus can be identified easily.
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Affiliation(s)
- S F Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
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