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Lavrador JP, Wroe-Wright O, Marchi F, Elhag A, O’Keeffe A, De La Fuente P, Soumpasis C, Cardia A, Mirallave-Pescador A, Díaz-Baamonde A, Mosquera JS, Coiteiro D, Jewell S, Strong A, Gullan R, Ashkan K, Vergani F, Vasan AK, Bhangoo R. Microvascular Cortical Dynamics in Minimal Invasive Deep-Seated Brain Tumour Surgery. Cancers (Basel) 2025; 17:1392. [PMID: 40361321 PMCID: PMC12070978 DOI: 10.3390/cancers17091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2025] [Revised: 04/02/2025] [Accepted: 04/03/2025] [Indexed: 05/15/2025] Open
Abstract
BACKGROUND The tubular retractor-assisted minimally invasive parafascicular approach (trMIPS) is a transsulcal approach to deep-seated brain tumours. It is a safe surgical approach but its impact on the microvascular dynamics of the retracted cortex and its clinical implications are unknown. METHODS This was a single-centre prospective study including patients with deep-seated brain tumours operated on with a trMIPS (BrainPath Nico System©). All patients underwent pre- and post-cannulation indocyanine green study using a FLOW 800 module in a KINEVO Zeiss© microscope. Speed, delay, time-to-peak (TtP) rise-in-time and cerebral blood flow index (CBFI) metrics were assessed. RESULTS Thirty-five patients were included, with 144 regions-of-interest (ROIs) selected. The majority of patients were diagnosed with glioblastoma (51.43%), and 37.14% of patients had a preoperative focal neurological deficit (FND) at presentation. A ROI-based analysis concluded that an increase in speed and CBFI was related with a worse neurological outcome when comparing the pre- and post-brain cannulation assessments (speed: deterioration = 43.12 ± 80.60% versus stable = -14.51 ± 57.80% versus improvement = 6.93 ± 31.33%, p < 0.0001; CBFI: deterioration = 50.40 ± 88.17% versus stable = -2.70 ± 67.54% versus improvement = -38.98 ± 26.17%, p = 0.0005). These findings were reproducible in a combined-ROI per patient analysis and confirmed after adjustment for confounding. CONCLUSION Microvascular flow dynamics impact trMIPS outcomes as an increase in the speed and CBFI after decannulation was related with worse neurological outcome.
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Affiliation(s)
- José Pedro Lavrador
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Oliver Wroe-Wright
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Francesco Marchi
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Lugano, Switzerland;
| | - Ali Elhag
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Andrew O’Keeffe
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Pablo De La Fuente
- Department of Neurosurgery, Araba University Hospital, 01009 Vitoria, Spain;
| | - Christos Soumpasis
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK;
| | - Andrea Cardia
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Lugano, Switzerland;
| | - Ana Mirallave-Pescador
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
- Department of Neurophysiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK
| | - Alba Díaz-Baamonde
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
- Department of Neurophysiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK
| | - Jose Sadio Mosquera
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
- Department of Neurophysiology, King’s College Hospital Foundation Trust, London SE5 9RS, UK
| | - Domingos Coiteiro
- Unidade de Saude Local, Hospital Santa Maria, 1649-028 Lisboa, Portugal;
| | - Sharon Jewell
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College University, London WC2R 2LS, UK; (S.J.); (A.S.)
| | - Anthony Strong
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College University, London WC2R 2LS, UK; (S.J.); (A.S.)
| | - Richard Gullan
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Francesco Vergani
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Ahilan Kailaya Vasan
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
| | - Ranjeev Bhangoo
- Department of Neurosurgery, King’s College Hospital Foundation Trust, London SE5 9RS, UK; (J.P.L.); (O.W.-W.); (A.E.); (A.O.); (A.M.-P.); (A.D.-B.); (J.S.M.); (R.G.); (K.A.); (F.V.); (A.K.V.); (R.B.)
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Van Den Hoven P, Osterkamp J, Nerup N, Svendsen MBS, Vahrmeijer A, Van Der Vorst JR, Achiam MP. Quantitative perfusion assessment using indocyanine green during surgery - current applications and recommendations for future use. Langenbecks Arch Surg 2023; 408:67. [PMID: 36700999 PMCID: PMC9879827 DOI: 10.1007/s00423-023-02780-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/12/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Incorrect assessment of tissue perfusion carries a significant risk of complications in surgery. The use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) presents a possible solution. However, only through quantification of the fluorescence signal can an objective and reproducible evaluation of tissue perfusion be obtained. This narrative review aims to provide an overview of the available quantification methods for perfusion assessment using ICG NIR fluorescence imaging and to present an overview of current clinically utilized software implementations. METHODS PubMed was searched for clinical studies on the quantification of ICG NIR fluorescence imaging to assess tissue perfusion. Data on the utilized camera systems and performed methods of quantification were collected. RESULTS Eleven software programs for quantifying tissue perfusion using ICG NIR fluorescence imaging were identified. Five of the 11 programs have been described in three or more clinical studies, including Flow® 800, ROIs Software, IC Calc, SPY-Q™, and the Quest Research Framework®. In addition, applying normalization to fluorescence intensity analysis was described for two software programs. CONCLUSION Several systems or software solutions provide a quantification of ICG fluorescence; however, intraoperative applications are scarce and quantification methods vary abundantly. In the widespread search for reliable quantification of perfusion with ICG NIR fluorescence imaging, standardization of quantification methods and data acquisition is essential.
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Affiliation(s)
- P Van Den Hoven
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
| | - J Osterkamp
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
| | - N Nerup
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
| | - M B S Svendsen
- CAMES Engineering, Copenhagen Academy for Medical Education and Simulation, Centre for Human Resources and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Alexander Vahrmeijer
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - J R Van Der Vorst
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - M P Achiam
- Department of Surgery and Transplantation, Copenhagen University Hospital Rigshospitalet, The Capital Region of Denmark, Copenhagen, Denmark
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Complementary Tools in Cerebral Bypass Surgery. World Neurosurg 2022; 163:50-59. [PMID: 35436579 DOI: 10.1016/j.wneu.2022.03.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
Cerebral revascularization surgery has been advanced by the refinement of several adjunctive tools. These tools include perioperative blood thinners, intraoperative spasmolytic agents, electrophysiological monitoring, and methods for assessing bypass patency or marking arteriotomies. Despite the array of options, the proper usage and comparative advantages of different complements in cerebral bypass have not been well-cataloged elsewhere. In this literature review, we describe the appropriate usage, benefits, and limitations of various bypass adjuncts. Understanding these adjuncts can help surgeons ensure that they receive reliable intraoperative information about bypass function and minimize the risk of serious complications. Overall, this review provides a succinct reference for neurosurgeons on various cerebrovascular bypass adjuncts.
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Sun Y, Wang Z, Jiang F, Yang X, Tan X, Chen Z, Liu Y, Zhu Y, Wang Z, Chen G. Utility of indocyanine green videoangiography with FLOW 800 analysis in brain tumour resection as a venous protection technique. BMC Surg 2022; 22:126. [PMID: 35366852 PMCID: PMC8976969 DOI: 10.1186/s12893-022-01573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In regard to central nervous system tumour resection, preserving vital venous structures to avoid devastating consequences such as brain oedema and haemorrhage is important. However, in clinical practice, it is difficult to obtain clear and vivid intraoperative venous visualization and blood flow analyses.
Methods
We retrospectively reviewed patients who underwent brain tumour resection with the application of indocyanine green videoangiography (ICG-VA) integrated with FLOW 800 from February 2019 to December 2020 and present our clinical cases to demonstrate the process of venous preservation. Galen, sylvian and superior cerebral veins were included in these cases.
Results
Clear documentation of the veins from different venous groups was obtained via ICG-VA integrated with FLOW 800, which semiquantitatively analysed the flow dynamics. ICG-VA integrated with FLOW 800 enabled us to achieve brain tumour resection without venous injury or obstruction of venous flux.
Conclusions
ICG-VA integrated with FLOW 800 is an available method for venous preservation, although further comparisons between ICG-VA integrated with FLOW 800 and other techniques of intraoperative blood flow monitoring is needed.
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Yim B, Gauden AJ, Steinberg GK. Application of FLOW 800 in extracranial-to-intracranial bypass surgery for moyamoya disease. NEUROSURGICAL FOCUS: VIDEO 2022; 6:V16. [PMID: 36284597 PMCID: PMC9555355 DOI: 10.3171/2021.10.focvid21191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022]
Abstract
The surgical treatment of moyamoya disease is heavily reliant upon a real-time understanding of cerebral hemodynamics. The application of FLOW 800 allows the surgeon to semiquantify the degree of perfusion to the cerebral cortex following extracranial-to-intracranial (EC-IC) bypass surgery. The authors present three illustrative cases demonstrating common intraoperative findings prior to and following anastomosis using FLOW 800. All patients were diagnosed by catheter angiogram with moyamoya disease and noninvasive imaging demonstrating hemispheric hypoperfusion. Superficial temporal artery (STA)–to–middle cerebral artery (MCA or M4) bypasses were performed to augment intracranial perfusion. The patients tolerated the procedures well and were discharged without event in stable neurological condition. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21191
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Affiliation(s)
- Benjamin Yim
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Andrew J. Gauden
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Gary K. Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
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Xue T, Deng R, Gao B, Wang Z, Ma C, You W, Zhu Y, Chen Z, Wang Z. Intraoperative indocyanine green video angiography (ICG-VA) with FLOW 800 software in complex intracranial aneurysm surgery. Chin Neurosurg J 2021; 7:28. [PMID: 34059164 PMCID: PMC8168317 DOI: 10.1186/s41016-021-00247-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/20/2021] [Indexed: 11/11/2022] Open
Abstract
Background Indocyanine green video angiography (ICG–VA) is a safe and effective instrument to assess changes in cerebral blood flow during cerebrovascular surgery. After ICG-VA, FLOW 800 provides a color-coded map to directly observe the dynamic distribution of blood flow and to calculate semiquantitative blood flow parameters later. The purpose of our study is to assess whether FLOW 800 is useful for surgery of complex intracranial aneurysms and to provide reliable evidence for intraoperative decision-making. Methods We retrospectively reviewed patients with complex aneurysms that underwent microsurgical and intraoperative evaluation of ICG-VA and FLOW 800 color-coded maps from February 2019 to May 2020. FLOW 800 data were correlated with patient characteristics, clinical outcomes, and intraoperative decision-making. Results The study included 32 patients with 42 complex aneurysms. All patients underwent ICG-VA FLOW 800 data provided semiquantitative data regarding localization, flow status in major feeding arteries; color maps confirmed relative adequate flow in parent, branching, and bypass vessels. Conclusions FLOW 800 is a useful supplement to ICG-VA for intraoperative cerebral blood flow assessment. ICG-VA and FLOW 800 can help to determine the blood flow status of the parent artery after aneurysm clipping and the bypass vessels after aneurysm bypass surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s41016-021-00247-z.
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Affiliation(s)
- Tao Xue
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Ruming Deng
- Department of Neurosurgery, Bozhou People's Hospital, Bozhou, Anhui Province, China
| | - Bixi Gao
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zilan Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Chao Ma
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Wanchun You
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Yun Zhu
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China
| | - Zhouqing Chen
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
| | - Zhong Wang
- Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.
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Investigating the blood-spinal cord barrier in preclinical models: a systematic review of in vivo imaging techniques. Spinal Cord 2021; 59:596-612. [PMID: 33742118 DOI: 10.1038/s41393-021-00623-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 02/25/2021] [Accepted: 03/01/2021] [Indexed: 01/31/2023]
Abstract
STUDY DESIGN This study is a systematic review. OBJECTIVES To evaluate current in vivo techniques used in the investigation of the blood-spinal cord barrier (BSCB). METHODS Search of English language literature for animal studies that investigated the BSCB in vivo. Data extraction included animal model/type, protocol for BSCB evaluation, and study outcomes. Descriptive syntheses are provided. RESULTS A total of 40 studies were included, which mainly investigated rodent models of experimental autoimmune encephalomyelitis (EAE) or spinal cord injury (SCI). The main techniques used were magnetic resonance imaging (MRI) and intravital microscopy (IVM). MRI served as a reliable tool to longitudinally track BSCB permeability changes with dynamic contrast enhancement (DCE) using gadolinium, or assess inflammatory infiltrations with targeted alternative contrast agents. IVM provided high-resolution visualization of cellular and molecular interactions across the microvasculature, commonly with either epi-fluorescence or two-photon microscopy. MRI and IVM techniques enabled the evaluation of therapeutic interventions and mechanisms that drive spinal cord dysfunction in EAE and SCI. A small number of studies demonstrated the feasibility of DCE-computed tomography, ultrasound, bioluminescent, and fluorescent optical imaging methods to evaluate the BSCB. Technique-specific limitations and multiple protocols for image acquisition and data analyses are described for all techniques. CONCLUSION There are few in vivo investigations of the BSCB. Additional studies are needed in less commonly studied spinal cord disorders, and to establish standardized protocols for data acquisition and analysis. Further development of techniques and multimodal approaches could overcome current imaging limitations to the spinal cord. These advancements might promote wider adoption of techniques, and can provide greater potential for clinical translation.
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Evaluation of Hemodynamic Change by Indocyanine Green-FLOW 800 Videoangiography Mapping: Prediction of Hyperperfusion Syndrome in Patients with Moyamoya Disease. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:8561609. [PMID: 32850003 PMCID: PMC7441439 DOI: 10.1155/2020/8561609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
Objective Hyperperfusion syndrome (HPS) after bypass surgery for moyamoya disease (MMD) mainly results from redistribution of blood flow, which leads to poor outcomes, while effective methods to predict HPS are still lacking. Indocyanine green (ICG) videoangiography can assess regional cerebral blood flow changes semiquantitatively with the application of FLOW 800 software. The purpose of this study was to investigate whether the intraoperative evaluation of local hemodynamic changes around anastomotic sites using FLOW 800 videoangiography mapping can predict the incidence of HPS and clinical outcomes. Methods Of the patients who were diagnosed with MMD in our hospital between August 2018 and December 2019, who underwent superficial temporal artery-middle cerebral artery bypass surgeries, we investigated 65 hemispheres (in 62 patients) in which intraoperative ICG analysis was performed using FLOW 800 (Zeiss Meditec, Oberkochen, Germany) to evaluate the local cerebral hemodynamics before and after anastomosis. Regions of interest were set at more than 2 points on the brain surface according to the location and situation of recipient arteries in the surgical area. Peak cerebral blood volume (CBV), regional cerebral blood flow (CBF), and time to peak (TTP) were calculated from the selected points. As the data were available intraoperatively, anastomoses were performed in a suitable area. According to the occurrence of HPS, patients were divided into the asymptomatic and symptomatic groups, from which hemodynamic parameters were compared. Furthermore, ROC analysis was performed to determine the diagnostic accuracy of change rates in CBV, CBF, and TTP (i.e., ΔCBV, ΔCBF, and ΔTTP) for predicting HPS. Results Data from the 62 patients were analyzed, and all patients were closely assessed during hospitalization after the procedures. The values of ΔCBV and ΔCBF were significantly higher in the symptomatic group (p < 0.01), while ΔTTP is slightly lower in the symptomatic group with no statistical differences (p = 0.72). Hemodynamic parameters including ΔCBV and ΔCBF, calculated by FLOW 800, had high sensitivity and specificity according to the ROC curve (ΔCBV: AUC = 0.743, 95% CI, 0.605-0.881, p = 0.002; ΔCBF: AUC = 0.852, 95% CI, 0.750-0.954, p < 0.01), which could be used as predictors for HPS. Conclusions Intraoperative ICG-FLOW 800 videoangiography mapping is a safe method which can reflect hemodynamic characteristics in the surgical area for MMD, the findings of which correlate with the occurrence of HPS. Parameters including ΔCBV and ΔCBF are proven to be efficient in the prediction of HPS.
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Nisson PL, McNamara MA, Wang X, Ding X. Occipital artery to p3 segment of posterior inferior cerebellar artery bypass in treating a complex fusiform aneurysm. BMJ Case Rep 2020; 13:13/6/e235023. [PMID: 32554452 DOI: 10.1136/bcr-2020-235023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We provide a case report of a 58-year-old man who presented with a ruptured fusiform dissecting aneurysm located at the junction of the vertebral artery and posterior inferior cerebellar artery (PICA). Due to the lesion's complexity, a two-step approach was planned for revascularisation of PICA using the occipital artery (OA) prior to coiling embolisation. An end-to-side OA-PICA bypass was performed with implantation at the caudal loop of the p3 PICA segment. Fifteen days after the procedure, the aneurysm underwent stent-assisted coiling for successful obliteration of the aneurysm. The patient tolerated this procedure well and now at 1.5 years of follow-up remains free from any neurological deficits (modified Rankin Score 0). This case report illustrates one of the unique scenarios where both the vascular territory involved and morphological features of the aneurysm prohibited the use of more conventional means, necessitating the use of an arterial bypass graft for successful treatment of this lesion. As open vascular surgery is becoming less common in the age of endovascular coiling, our article uniquely reports on the combined use of both endovascular and microsurgical techniques to treat a complex aneurysm of the posterior circulation.
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Affiliation(s)
- Peyton L Nisson
- Department of Neurosurgery, Cedars-Sinai, Los Angeles, California, USA
| | - Michael A McNamara
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Xiaolong Wang
- Departmetn of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, Shanxi, China
| | - Xinmin Ding
- Departmetn of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, Shanxi, China
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Rennert RC, Strickland BA, Russin JJ. Commentary: Whole-Field Indocyanine Green Intensity Analysis to Intraoperatively Predict Cerebral Hyperperfusion Syndrome Following Superficial Temporal Artery-Middle Cerebral Artery Bypass: A Retrospective Case-Control Study in 7-Year Experience With 112 Cases. Oper Neurosurg (Hagerstown) 2020; 18:E193-E194. [PMID: 31642498 DOI: 10.1093/ons/opz322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/02/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, University of California San Diego, San Diego, California
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- Neurorestoration Center, Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
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