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Vega-Moreno DA, Janković D, Azouz H, Nakipuria M, Kato Y. Dual Microscope Indocyanine Green Video Angiography and Endoscopic Review to Treat Intracranial Aneurysm: A Review of the Literature Regarding a Case. Asian J Neurosurg 2023; 18:701-707. [PMID: 38161615 PMCID: PMC10756820 DOI: 10.1055/s-0043-1775584] [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] [Indexed: 01/03/2024] Open
Abstract
The use of the indocyanine green video angiography (ICG-VA) both endoscope and microscope has become popular in recent decades thanks to the safety, efficacy, and added value that they have provided for cerebrovascular surgery. The dual use of these technologies is considered complementary and has helped cerebrovascular surgeons in decision-making, especially for aneurysm clipping surgery; however, its use has been described for both aneurysm surgery, resection of arteriovenous malformations, or even for bypass surgeries. We conducted a review of the literature with the MeSH terms "microscope indocyanine green video angiography (mICG-VA)," "endoscopic review," AND/OR "intracranial aneurysm." A total of 97 articles that included these terms were selected after a primary review to select a total of 26 articles for the final review. We also present a case to exemplify its use, in which we use both technological tools for the description of the aneurysm, as well as for decision-making at the time of clipping and for reclipping. Both tools, both the use of the endoscope and the mICG-VA, have helped decision-making in neurovascular surgery. A considerable clip replacement rate has been described with the use of these technologies, which has helped to reduce the complications associated with poor clipping. One of the main advantages of their usefulness is that they are tools for intraoperative use, which is why they have shown superiority compared to digital subtraction angiography, which takes longer to use and has a higher risk of complications associated with the contrast medium. On the other hand, a very low rate of complications has been described with the use of the endoscope and mICG-VA, which is why they are considered safe tools to use. In some cases, mention has been made of the use of one or the other technology; however, we consider that its dual use provides more information about the status of the clip, its anatomy, its relationship with other vascular structures, and the complete occlusion of the aneurysm. We consider that the use of both technologies is complementary, so in case of having them both should be used, since both the endoscope and the mICG-VA provide additional and useful information.
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Affiliation(s)
- Daniel Alejandro Vega-Moreno
- Neurosurgery Department, Postgraduate Division, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Dragan Janković
- Neurosurgery Department, University Hospital Mainz, Maguncia, Germany
| | - Heba Azouz
- Neurosurgery Department, Childreńs Cancer Hospital Egypt, Cairo, Egypt
| | | | - Yoko Kato
- Neurosurgery Department, Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Aichi, Japan
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Weinzierl A, Barbon C, Gousopoulos E, von Reibnitz D, Giovanoli P, Grünherz L, Lindenblatt N. Benefits of robotic-assisted lymphatic microsurgery in deep anatomical planes. JPRAS Open 2023; 37:145-154. [PMID: 37546233 PMCID: PMC10403710 DOI: 10.1016/j.jpra.2023.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/09/2023] [Indexed: 08/08/2023] Open
Abstract
Micro- and supermicrosurgeries have become standard techniques for lymphatic reconstruction. As increasingly smaller vessels are being targeted, robotic-assisted surgery has emerged as a new approach to push reconstructive limits owing to its ability of motion scaling and providing better accessibility of deep anatomical regions. The precision of the robot is achieved at the expense of operating speed among other variables; therefore, the surgeon must weigh the enhanced dexterity against the additional operating time and cost required for the robotic surgical system itself to ensure optimal resource utilization. Here we present a case series of 8 patients who underwent robot-assisted lymphatic microsurgery for omental flap transfer to the axilla and lympho-venous anastomosis. The Symani® Surgical System was used with a conventional microscope or 3D exoscope. The use of 3D exoscope provided clear benefits in terms of surgeon positioning. Moreover, access to the recipient vessels near the thoracic wall was significantly improved with the robotic setup. In addition, suture precision was excellent, resulting in patent anastomoses. Operating time for anastomosis was comparable to that for manual anastomosis and demonstrated a steep learning curve. The benefits of robotic systems in operating fields with good exposure require further evaluation. However, owing to longer instruments, additional stability, dexterity, and motion precision, robotic systems offer a marked advantage for operating in deep anatomical planes and on small structures. A potentially new field for the implementation of robotic surgery is central lymphatic reconstruction. Progress in terms of operating time and cost is crucial, and future research should validate the effectiveness of robotic-assisted surgery in larger clinical studies.
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Affiliation(s)
| | | | | | | | | | | | - Nicole Lindenblatt
- Corresponding author: Prof. Dr. med. Nicole Lindenblatt, Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland, Tel.: +41-255-44-1111.
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Murakami T, Toyota S, Nakagawa K, Hagioka T, Hoshikuma Y, Suematsu T, Shimizu T, Kobayashi M, Taki T. Midline suboccipital approach to a vertebral artery–posterior inferior cerebellar artery aneurysm from the rostral end of the patient using ORBEYE. Surg Neurol Int 2022; 13:87. [PMID: 35399900 PMCID: PMC8986755 DOI: 10.25259/sni_1272_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/11/2022] [Indexed: 02/02/2023] Open
Abstract
Background:
The midline suboccipital approach with the patient in the prone position is safe and effective for clipping vertebral artery–posterior inferior cerebellar artery (VA–PICA) aneurysms. Using a conventional surgical microscope from the rostral end of the patient for this approach without an extreme head-down position requires the surgeon to overhang the visual axis of the microscope and perform surgical manipulations in an uncomfortable posture. We report performing the midline suboccipital approach from the rostral end with slight head-down position using ORBEYE, a new high-definition (4K) three-dimensional exoscope.
Case Description:
A 65-year-old woman was admitted for clipping of a right unruptured VA–PICA aneurysm (maximum diameter, 5mm) located medially and ventral to the hypoglossal canal. After induction of general anesthesia, the patient was placed in the prone position with the head titled slightly downward. A midline suboccipital approach was performed from the rostral end of the patient using ORBEYE. Clipping was safely accomplished in a comfortable posture. No operative complications occurred. Postoperative computed tomography angiography showed complete aneurysmal obstruction.
Conclusion:
Exoscopic surgery using ORBEYE is feasible for a midline suboccipital approach to VA–PICA aneurysms from the rostral end of the patient with the patient in the prone with slight head-down position.
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Noro S, Seo Y, Honjo K, Okuma M, Asayama B, Amano Y, Kyono M, Hashimoto M, Hanai K, Nakamura H. Lateral Supracerebellar Infratentorial Approach for Superior Oblique Myokymia: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:101-105. [PMID: 35234412 DOI: 10.1227/ons.0000000000000015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 09/13/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Few reports have shown that superior oblique myokymia (SOM) may result from vascular compression of the trochlear nerve and may be curable using microvascular decompression (MVD). OBJECTIVE To report the clinical characteristics and surgical treatment of 2 cases of SOM and provide a review of the related literature. METHODS Two patients with SOM were treated using MVD with the lateral supracerebellar infratentorial approach. The patients underwent diagnostic magnetic resonance imaging and three-dimensional fusion imaging preoperatively. A lateral suboccipital craniotomy was performed in the park-bench position. The trochlear nerve and branches of the superior cerebellar artery were confirmed after opening the cerebellomesencephalic fissure over the tentorial surface of the cerebellum. The vessel, which compressed the root exit zone of the trochlear nerve, was transposed far from the nerve and attached to the surface of the midbrain using Teflon felt and fibrin glue. RESULTS The first case showed compression on both the ventral and rostral sides of the trochlear nerve root exit zone, and the second showed compression only on the ventral side. Large bridging veins on the tentorial surface of the cerebellum complicated the approach in the second case. Postoperatively, both patients had immediate and complete resolution of symptoms without recurrence at the 24-mo and 17-mo follow-ups, respectively. Five previous reports described the complete resolution of SOM after MVD. CONCLUSION A presentation of an intermittent fluttering ocular sensation should prompt magnetic resonance imaging for ipsilateral trochlear nerve compression. The lateral supracerebellar infratentorial approach allows safe and efficacious MVD for SOM.
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Affiliation(s)
- Shusaku Noro
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yoshinobu Seo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Kaori Honjo
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Masahiro Okuma
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Bunsho Asayama
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Yuki Amano
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Masanori Kyono
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
| | - Masato Hashimoto
- Department of Ophthalmology, Nakamura Memorial Hospital, Sapporo, Japan
| | - Kaori Hanai
- Department of Ophthalmology, Nakamura Memorial Hospital, Sapporo, Japan
| | - Hirohiko Nakamura
- Department of Neurosurgery, Nakamura Memorial Hospital, Sapporo, Japan
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Kato N, Terao T, Ishii T, Saito E, Hirokawa Y, Michishita S, Sasaki Y, Tani S, Murayama Y. Subclavian Artery Flow Dynamics Evaluated by Analytical Intraoperative Indocyanine Green Videoangiography During Surgical Treatment of Thoracic Outlet Syndrome: A Case Series. Oper Neurosurg (Hagerstown) 2022; 22:115-122. [PMID: 34989707 DOI: 10.1227/ons.0000000000000077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/29/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Indocyanine green (ICG) videoangiography is rarely used during the surgical treatment of thoracic outlet syndrome (TOS). OBJECTIVE To evaluate subclavian artery (SA) flow dynamics using the analytical ICG videoangiography during TOS surgeries. METHODS We examined patients with neurogenic TOS who received surgical treatment and whose SA blood flow at the interscalene space was evaluated using ICG videoangiography equipped with an analytical function (FLOW800). Anterior scalenectomy with or without middle scalenectomy and first rib resection were conducted for decompression of the brachial plexus. ICG videoangiography was performed before and after decompression of the brachial plexus. After acquisition of grayscale and color-coded maps, a region of interest was placed in the SA to obtain time-intensity diagrams. Maximum intensity (MI), rise time (RT), and blood flow index (BFi) were calculated from the diagram, in arbitrary intensity (AI) units. We compared values before and after decompression. Comparisons of the three parameters before and after decompression were assessed statistically using the paired t-tests and Wilcoxon signed-rank test. RESULTS We evaluated nine procedures in consecutively presenting patients. The observed mean values of MI, RT, and BFi before decompression were 174.1 ± 61.5 AI, 5.2 ± 1.1 s, and 35.2 ± 13.5 AI/s, respectively, and the observed mean values of MI, RT, and BFi after decompression were 299.3 ± 167.4 AI, 6.6 ± 0.8 s, and 44.6 ± 28.3 AI/s, respectively. These parameters showed higher values after decompression than before decompression, and the increase in MI and RT was statistically significant (P < .05). CONCLUSION ICG videoangiography allows semiquantitative evaluation of hemodynamic changes during TOS surgery. A marked decrease in the velocity of SA flow was observed after decompression.
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Affiliation(s)
- Naoki Kato
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Tohru Terao
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | - Takuya Ishii
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University Daisan Hospital, Tokyo, Japan
| | - Emiko Saito
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | - Yusuke Hirokawa
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan
| | | | - Yuichi Sasaki
- Department of Neurosurgery, Atsugi City Hospital, Kanagawa, Japan.,Department of Neurosurgery, The Jikei University School of Medicine Tokyo, Tokyo, Japan
| | - Satoshi Tani
- 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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