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. 2017 Aug 22:8:201.
doi: 10.4103/sni.sni_202_17. eCollection 2017.

Usefulness of dural surface tracing of the cortical vessels with indocyanine green videoangiography just prior to dural opening for various cerebrovascular diseases

Naoki Otani  1 , Kojiro Wada  1 , Terushige Toyooka  1 , Satoru Takeuchi  1 , Arata Tomiyama  1 , Kentaro Mori  1
Affiliations

Usefulness of dural surface tracing of the cortical vessels with indocyanine green videoangiography just prior to dural opening for various cerebrovascular diseases

Naoki Otani et al. Surg Neurol Int. .

Abstract

Background: Indocyanine green (ICG) videoangiography can be used to delineate the locations of the cortical vessels just prior to dural opening, allowing safe and optimal dural opening. The present clinical series demonstrates the adjunct use of ICG videoangiography to optimize dural opening for the treatment of various cerebrovascular diseases.

Methods: A total of 45 patients underwent surgery for superficial temporal artery-middle cerebral artery bypass (40), arteriovenous malformation (2), and dural arteriovenous fistula (3) between January 2012 and December 2016. After the dura had been exposed, ICG (0.25 mg/kg) was administered intravenously from the peripheral vein as a bolus just prior to dural opening. The operating microscope equipped with a fluorescent filter was used to examine the illuminated field of interest, and real-time flow assessment of the underlying cortical vessels and/or dural sinus was performed. The target recipient arteries for anastomosis or vascular malformations were visualized through the dura and marked using a pyoktanin pen on the dura mater.

Results: The optimal dural opening was performed for anastomosis, and safety was ensured by locating the vascular malformations through the dura mater in all cases. The cortical vessel injury was avoided in all cases. No complication was related to this procedure.

Conclusions: Dural surface tracing of the cortical vessels with ICG videoangiography just prior to dural opening is a useful technique, which allows optimal and safe dural opening for treatment of various cerebrovascular diseases.

Keywords: Dural opening; ICG videoangiography; microneurosurgery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic illustrations showing the surgical procedures of tracing of the cortical vessels on the dural surface with ICG videoangiography. The operating microscope equipped with a fluorescent filter was used to examine the illuminated field of interest, and real-time flow assessment of the underlying cortical vessels and dural sinus was performed (a and b). The dural and cortical vessels were visualized through the dura and marked using a pyoktanin pen on the dura mater (c). Finally, optimal and safe dural incision was performed (d)
Figure 2
Figure 2
A patient with symptomatic right M1 stenosis underwent STA-M4 double bypass (a). Fronto-temporal craniotomy was planned (b). Just prior to dural opening, ICG (0.25 mg/kg) was administered intravenously. The preoperatively scheduled recipient cortical arteries were visualized through the dura and marked using a pyoktanin pen on the dura mater (c-e). Optimal opening of the dura mater was performed (f)
Figure 3
Figure 3
A patient with symptomatic moyamoya disease underwent STA-M4 double bypass (a). Fronto-temporal craniotomy was planned (b). Just prior to dural opening, ICG (0.25 mg/kg) was administered intravenously. The cortical vessels were visualized through the dura and marked using a pyoktanin pen on the dura mater (c and d). The candidates for the recipient cortical arteries were located over the dura mater, and then optimal opening of the dura mater was performed for anastomosis (e)
Figure 4
Figure 4
A patient with ruptured AVM underwent removal of the AVM in the acute stage (a). Just prior to dural opening, ICG (0.25 mg/kg) was administered intravenously, and real-time flow assessment of the underlying cortical vessels was performed. The cortically located nidus, feeders, and draining veins were visualized through the dura and marked using a pyoktanin pen on the dura mater (b and c). The dura mater was safely and accurately opened (d)
Figure 5
Figure 5
A patient with dural AVF with cortical reflux underwent direct removal (a). Bicoronal craniotomy was planned (b). Just prior to dural opening, ICG (0.25 mg/kg) was administered intravenously. The varix and cortical draining veins were visualized through the dura and marked using a pyoktanin pen on the dura mater (c and d). The dura mater was safely and accurately opened (e). Varix lesion and the fistula were confirmed to coincide with the findings of ICG videoangiography (f). After resection of the lesion, final ICG videoangiography showed the lesion had disappeared (g)
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References

    1. Dashti R, Laakso A, Niemelä M, Porras M, Hernesniemi J. Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: The Helsinki experience. Surg Neurol. 2009;71:543–50. - PubMed
    1. Nussbaum ES, Defillo A, Nussbaum L. The use of indocyanine green videoangiography to optimize the dural opening for intracranial parasagittal lesions. Neurosurgery. 2012;70(1 Suppl Operative):61–3. - PubMed
    1. Roessler K, Krawagna M, Dörfler A, Buchfelder M, Ganslandt O. Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: Conclusions from 295 consecutively clipped aneurysms and review of the literature. Neurosurg Focus. 2014;36:E7. - PubMed
    1. Schaller C, Urbach H, Schramm J, Meyer B. Role of venous drainage in cerebral arteriovenous malformation surgery, as related to the development of postoperative hyperperfusion injury. Neurosurgery. 2012;51:921–7. - PubMed
    1. Torné R, Rodríguez-Hernández A, Lawton MT. Intraoperative arteriovenous malformation rupture: Causes, management techniques, outcomes, and the effect of neurosurgeon experience. Neurosurg Focus. 2014;37:E12. - PubMed

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