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Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery


Esposito, Giuseppe; Burkhardt, Jan-Karl; Bozinov, Oliver; Regli, Luca (2016). Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery. Acta Neurochirurgica, 158(3):565-570.

Abstract

BACKGROUND Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass remains an essential tool for managing complex cerebrovascular conditions. A crucial surgical step is the identification and safe dissection of the bypass donor artery. If the frontal branch of the STA is used, a curvilinear fronto-temporal scalp flap generally allows for a clean dissection from the underside of the scalp flap. This dissection is sometimes tedious, since the frontal branch is not always easily visible and due to variability of its anatomy. With this article, we report on the feasibility and effectiveness of a simple indocyanine green videoangiography (ICG-VA)-assisted technique for the identification of the STA branches from the underside of a fronto-temporal scalp flap in bypass surgery.
METHODS The technique is based on the analysis of the difference in timing of filling of scalp vessels illuminated via ICG-VA from the underside of a scalp flap. Three illustrative cases are reported.
RESULTS ICG-VA permitted the correct identification and safe dissection of the donor vessels (STA branches) in all three patients. There were no complications due to the ICG-VA.
CONCLUSIONS This technique allows reliable visualization of the STA and its branches at once before microsurgical dissection. The information provided by ICG-VA enables precise mapping and preparation of the STA. The simplicity and safety of this technique make it an effective tool for intraoperative identification of the STA and its branches.

Abstract

BACKGROUND Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass remains an essential tool for managing complex cerebrovascular conditions. A crucial surgical step is the identification and safe dissection of the bypass donor artery. If the frontal branch of the STA is used, a curvilinear fronto-temporal scalp flap generally allows for a clean dissection from the underside of the scalp flap. This dissection is sometimes tedious, since the frontal branch is not always easily visible and due to variability of its anatomy. With this article, we report on the feasibility and effectiveness of a simple indocyanine green videoangiography (ICG-VA)-assisted technique for the identification of the STA branches from the underside of a fronto-temporal scalp flap in bypass surgery.
METHODS The technique is based on the analysis of the difference in timing of filling of scalp vessels illuminated via ICG-VA from the underside of a scalp flap. Three illustrative cases are reported.
RESULTS ICG-VA permitted the correct identification and safe dissection of the donor vessels (STA branches) in all three patients. There were no complications due to the ICG-VA.
CONCLUSIONS This technique allows reliable visualization of the STA and its branches at once before microsurgical dissection. The information provided by ICG-VA enables precise mapping and preparation of the STA. The simplicity and safety of this technique make it an effective tool for intraoperative identification of the STA and its branches.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neurosurgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:19 January 2016
Deposited On:26 Jan 2017 14:16
Last Modified:02 Feb 2018 09:49
Publisher:Springer
ISSN:0001-6268
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00701-016-2703-x
PubMed ID:26783025

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