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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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Klingler JH, Gizaw C, Blaß BI, Hohenhaus R, Neidert N, Neumann-Haefelin E, Kotsis F, Grauvogel J, Scheiwe C, Beck J. Intraoperative indocyanine green (ICG) videoangiography in spinal hemangioblastoma surgery - helpful tool or unnecessary? Clin Neurol Neurosurg 2025; 248:108661. [PMID: 39603110 DOI: 10.1016/j.clineuro.2024.108661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2024] [Revised: 11/19/2024] [Accepted: 11/23/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND Hemangioblastomas are highly vascularized tumors that may be associated with extensive architecture of the surrounding pathological vessels. The distinction between feeding arteries and draining veins is usually not obvious during microsurgical en-bloc tumor resection. The aim of this investigation is to provide recommendations in which hemangioblastomas intraoperative indocyanine green (ICG) videoangiography might be beneficial for safe en-bloc tumor resection. METHODS This is a single-center retrospective review of resected spinal hemangioblastomas over a 59-month period to identify operations in which ICG videoangiography was used. We analyzed whether intraoperative ICG videoangiography is useful for identifying possible feeding arteries and draining veins. The identified benefits and shortcomings of this technique were summarized. RESULTS In total, 39 patients had surgery for removal of spinal hemangioblastomas. Intraoperative ICG videoangiography was performed in 26 surgeries for resection of spinal hemangioblastomas (66.7 %). In 25 of 27 removed hemangioblastomas (92.6 %), intraoperative ICG videoangiography yielded useful insights about the vascularization of the tumor and as thus regarded as helpful. In two cases, the pathological vessels could not be clearly assigned to feeding arteries or draining vessels. Complete tumor removal was achieved in all patients. CONCLUSION ICG videoangiography offers real-time intraoperative visualization of the tumor vasculature and can therefore improve surgical decision-making. Ideally, direct microscopic visualization of the structures to be assessed should be aimed for in ICG videoangiography. The information gained from ICG videoangiography may be limited in the case of tumors or vessels that lie deeper or are covered by the myelon or other structures.
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Affiliation(s)
- Jan-Helge Klingler
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Christine Gizaw
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bianca-Ioana Blaß
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Romina Hohenhaus
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nicolas Neidert
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elke Neumann-Haefelin
- Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fruzsina Kotsis
- Department of Medicine IV, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Grauvogel
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Scheiwe
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Hsu A, Mu SZ, James A, Ibrahim MA, Saber AA. Indocyanine Green in Bariatric Surgery: a Systematic Review. Obes Surg 2023; 33:3539-3544. [PMID: 37713041 DOI: 10.1007/s11695-023-06801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/16/2023]
Abstract
Indocyanine green (ICG) is a fluorescent dye that can be used intraoperatively to assess tissue perfusion, as well as perform leak testing. This study aims to summarize published manuscripts on outcomes of ICG use and reduction of complications compared to traditional leak test and tissue perfusion evaluation. A PubMed search using "ICG and bariatric surgery," "ICG and gastric sleeve," "ICG and gastric bypass," and "ICG and revisional bariatric surgery" was performed. The proportion of patients who underwent an intraoperative decision change due to ICG was 3.8% (95% CI: 2.0 to 7.2%). ICG fluorescent imaging in bariatric surgery is a valuable tool, and further studies are needed to confirm its utility for routine use in both standard or complex cases (PROSPERO #418126).
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Affiliation(s)
- Angel Hsu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Scott Z Mu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Abi James
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Mina A Ibrahim
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA
| | - Alan A Saber
- Department of Metabolic and Bariatric Surgery, Newark Beth Israel Medical Center, 201 Lyons Ave, Newark, NJ, 07112, USA.
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Elbeltagy M, Abbassy M. Neurofibromatosis type1, type 2, tuberous sclerosis and Von Hippel-Lindau disease. Childs Nerv Syst 2023; 39:2791-2806. [PMID: 37819506 DOI: 10.1007/s00381-023-06160-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/16/2023] [Indexed: 10/13/2023]
Abstract
Neurocutaneous syndromes (also known as phakomatoses) are heterogenous group of disorders that involve derivatives of the neuroectoderm. Each disease has diagnostic and pathognomonic criteria, once identified, thorough clinical examination to the patient and the family members should be done. Magnetic resonance imaging (MRI) is used to study the pathognomonic findings withing the CNS (Evans et al. in Am J Med Genet A 152A:327-332, 2010). This chapter includes the 4 most common syndromes faced by neurosurgeons and neurologists; neurofibromatosis types 1 and 2, tuberous sclerosis and Von Hippel-Lindau disease. Each syndrome has specific genetic anomaly that involves a tumor suppressor gene and the loss of inhibition of specific pathways. The result is a spectrum of cutaneous manifestations and neoplasms.
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Affiliation(s)
- M Elbeltagy
- Department of Neurosurgery, Cairo University, 1 University Street, Giza Governorate, 12613, Egypt.
- Department of Neurosurgery, Children's Cancer Hospital Egypt, Sekat Hadid Al Mahger, Zeinhom, El Sayeda Zeinab, Cairo Governorate, 4260102, Egypt.
| | - M Abbassy
- Department of Neurosurgery, Children's Cancer Hospital Egypt, Sekat Hadid Al Mahger, Zeinhom, El Sayeda Zeinab, Cairo Governorate, 4260102, Egypt
- Department of Neurosurgery, Alexandria University, 22 El-Gaish Rd, Al Azaritah WA Ash Shatebi, Bab Sharqi, Alexandria Governorate, 5424041, Egypt
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Yamaguchi I, Kanematsu Y, Shimada K, Yamamoto N, Korai M, Miyake K, Miyamoto T, Sogabe S, Shikata E, Ishihara M, Yamamoto Y, Kuroda K, Takagi Y. Evaluation of Serial Intra-Arterial Indocyanine Green Videoangiography in the Surgical Treatment of Cranial and Craniocervical Junction Arteriovenous Fistulae: A Case Series. Oper Neurosurg (Hagerstown) 2023; 25:292-300. [PMID: 37345942 DOI: 10.1227/ons.0000000000000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/20/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Intravenous indocyanine green (IV-ICG) videoangiography is commonly performed to detect blood flow in the microscopic view. However, intra-arterial ICG (IA-ICG) videoangiography provides high-contrast imaging, repeatability within a short period of time, and clear-cut separation of the arterial and venous phases compared with IV-ICG. These features are useful for detecting retrograde venous drainage (RVD) and shunt occlusion in arteriovenous fistulae (AVF) surgery. This study aimed to investigate whether IA-ICG videoangiography can be repeatable within a short period of time and be useful for detecting RVD and shunt occlusion in cranial- and craniocervical junction (CCJ)-AVF surgery. METHODS Between January 2012 and December 2022, 50 patients were treated with endovascular or surgical intervention for cranial- and CCJ-AVF at Tokushima University Hospital. Of these, 5 patients (6 lesions) underwent open surgery with IA-ICG videoangiography in a hybrid operating room. We analyzed the data of these 5 patients (6 lesions). RESULTS There were 4/patient (median, range 2-12) and 3.5/lesion (median, range 2-10) intraoperative IA-ICG runs. IA-ICG videoangiography detected RVD in all patients. Clearance of IA-ICG-induced fluorescence was achieved within 30 seconds in all patients at each region of interest. After the disconnection of the fistulae, IA-ICG videoangiography and intraoperative digital subtraction angiography (DSA) confirmed the disappearance of RVD in all patients. There were no complications associated with IA-ICG videoangiography. CONCLUSION This study showed that IA-ICG videoangiography is repeatable within a short period of time before and after obliteration and can be useful for detecting RVD and shunt occlusion in cranial- and CCJ-AVF surgery. IA-ICG videoangiography also allows intraoperative DSA studies in a hybrid operating room. Considering the recent advancements in hybrid operating rooms, combining IA-ICG videoangiography with intraoperative DSA is a useful strategy for cranial- and CCJ-AVF surgery.
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Affiliation(s)
- Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kenji Shimada
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Nobuaki Yamamoto
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazuhisa Miyake
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Eiji Shikata
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Manabu Ishihara
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yuki Yamamoto
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kazutaka Kuroda
- Department of Neurology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Shimada K, Miyake K, Yamaguchi I, Sogabe S, Korai M, Kanematsu Y, Takagi Y. Efficacy of Utilizing Both 3-Dimensional Multimodal Fusion Image and Intra-Arterial Indocyanine Green Videoangiography in Cerebral Arteriovenous Malformation Surgery. World Neurosurg 2023; 169:e260-e269. [PMID: 36332776 DOI: 10.1016/j.wneu.2022.10.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE An understanding of the complex morphology of an arteriovenous malformation (AVM) is important for successful resection. We have previously reported the utility of intra-arterial indocyanine green (ICG) videoangiography for this purpose, but that method cannot detect the angioarchitecture covered by brain tissue. 3-dimensional (3D) multimodal fusion imaging is reportedly useful for this same purpose, but cannot always visualize the exact angioarchitecture due to poor source images and processing techniques. This study examined the results of utilizing both techniques in patients with AVMs. METHODS Both techniques were applied in 12 patients with AVMs. Both images were compared with surgical views and evaluated by surgeons. RESULTS Although evaluations for identifying superficial feeders by ICG videoangiography were high in all cases, the more complicated the AVM, the lower the evaluation by 3D multimodal fusion imaging. Conversely, evaluation of the estimated range of the nidus was high in all cases by 3D multimodal fusion imaging, but low in all but one case by ICG videoangiography. Nidus flow reduction was recognized by Flow 800 analysis obtained after ICG videoangiography. CONCLUSIONS These results showed that utilizing both techniques together was more useful than each modality alone in AVM surgery. This was particularly effective in identifying superficial feeders and estimating the range of the nidus. This technique is expected to offer an optimal tool for AVM surgery.
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Affiliation(s)
- Kenji Shimada
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan.
| | - Kazuhisa Miyake
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Masaaki Korai
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
| | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima, Tokushima, Japan
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Shimada K, Yamaguchi I, Miyamoto T, Sogabe S, Miyake K, Kanematsu Y, Takagi Y. Efficacy of intraarterial indocyanine green videoangiography in surgery for arteriovenous fistula at the craniocervical junction in a hybrid operating room: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE22100. [PMID: 35733826 PMCID: PMC9204929 DOI: 10.3171/case22100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Sufficient understanding of the angioarchitecture of an arteriovenous fistula (AVF) at the craniocervical junction (CCJ) is crucial to surgical treatment but is often difficult because of the complex vascular anatomy. Intraarterial indocyanine green (ICG) videoangiography has emerged as a more useful option for understanding the vascular anatomy than intravenous ICG videoangiography. This report describes two cases of CCJ AVFs successfully treated by surgery using intraarterial ICG videoangiography and describes the efficacy of this technique.
OBSERVATIONS
Case 1 involved a 71-year-old man presenting with tetraparesis after sudden onset of severe headache due to subarachnoid hemorrhage (SAH). Digital subtraction angiography (DSA) demonstrated CCJ epidural AVF. Intraarterial ICG videoangiography revealed the drainer, which had been difficult to identify. The AVF disappeared after disconnection of the drainer. Case 2 involved a 68-year-old man presenting with severe headache due to SAH. DSA showed multiple AVFs at the CCJ and cerebellar tentorium. Intraarterial ICG videoangiography demonstrated concomitant perimedullary AVF and dural AVF at the CCJ. All AVFs disappeared postoperatively.
LESSONS
Intraarterial ICG videoangiography was useful for definitive diagnosis of CCJ AVF, facilitating identification of feeders and drainers with bright and high phase contrast and allowing repeated testing to confirm flow direction.
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Affiliation(s)
- Kenji Shimada
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Izumi Yamaguchi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Takeshi Miyamoto
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Shu Sogabe
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | - Kazuhisa Miyake
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
| | | | - Yasushi Takagi
- Department of Neurosurgery, Tokushima University, Tokushima, Japan
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