Indocyanine Green (ICG) Videoangiography-Guided Dissection of the Sylvian Fissure on the Transsylvian Approach: Technical Note

Motoyama, Yasushi; Gurung, Pritam; Takeshima, Yukio; Nakagawa, Ichiro; Park, Young-Soo; Nakase, Hiroyuki

doi:10.1016/j.wneu.2015.11.069

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…27 ICG-VA, and more recently the evolution of FLOW 800 analysis, has been used to guide neurosurgical procedures, including vascular and tumor disease. 5,7,9,10,[16][17][18]22,26,29,37 We were the first group to propose the use of ICG-VA to study the venous flow dynamics and to develop an ICG temporary clipping test to predict the effect of venous sacrifice. 13,15 In this study, we expanded our experience in venous flow evaluation by applying the FLOW 800 analysis in all cases, with a better interpretation of flow data and understanding the pathophysiology of venous circulation.…”

Section: Discussionmentioning

confidence: 99%

Use of ICG videoangiography and FLOW 800 analysis to identify the patient-specific venous circulation and predict the effect of venous sacrifice: a retrospective study of 172 patients

Acerbi

Vetrano

Sattin

et al. 2018

Neurosurgical Focus

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OBJECTIVEThe best management of veins encountered during the neurosurgical approach is still a matter of debate. Even if venous sacrifice were to lead to devastating consequences, under certain circumstances, it might prove to be desirable, enlarging the surgical field or increasing the extent of resection in tumor surgery. In this study, the authors present a large series of patients with vascular or oncological entities, in which they used indocyanine green videoangiography (ICG-VA) with FLOW 800 analysis to study the patient-specific venous flow characteristics and the management workflow in cases in which a venous sacrifice was necessary.METHODSBetween May 2011 and December 2017, 1972 patients were admitted to the authors’ division for tumor and/or neurovascular surgery. They retrospectively reviewed all cases in which ICG-VA and FLOW 800 were used intraoperatively with a specific target in the venous angiographic phase or for the management of venous sacrifice, and whose surgical videos and FLOW 800 analysis were available.RESULTSA total of 296 ICG-VA and FLOW 800 studies were performed intraoperatively. In all cases, the venous structures were clearly identifiable and were described according to the flow direction and speed. The authors therefore defined different patterns of presentation: arterialized veins, thrombosed veins, fast-draining veins with anterograde flow, slow-draining veins with anterograde flow, and slow-draining veins with retrograde flow. In 16 cases we also performed a temporary clipping test to predict the effect of the venous sacrifice by the identification of potential collateral circulation.CONCLUSIONSICG-VA and FLOW 800 analysis can provide complete and real-time intraoperative information regarding patient-specific venous drainage pattern and can guide the decision-making process regarding venous sacrifice, with a possible impact on reduction of surgical complications.

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Section: Discussionmentioning

confidence: 99%

Use of ICG videoangiography and FLOW 800 analysis to identify the patient-specific venous circulation and predict the effect of venous sacrifice: a retrospective study of 172 patients

Acerbi

Vetrano

Sattin

et al. 2018

Neurosurgical Focus

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“…Motoyama et al reported a similar case involving a patient with thin SAH. 18) We believe that our series offers the first report of ICG for Sylvian veins covered with SAH. Seven aneurysmal SAH patients underwent clipping with this procedure, and Sylvian ICG images were clearly observed in all cases.…”

Section: Discussionmentioning

confidence: 69%

Utility of Indocyanine Green Video Angiography for Sylvian Fissure Dissection in Subarachnoid Hemorrhage Patients - Sylvian ICG Technique

Toi

Matsushita

Ogawa

et al. 2018

Neurol. Med. Chir.(Tokyo)

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Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes. This procedure was termed “Sylvian ICG”. We observed ICG fluorescence quickly in all cases. Sylvian veins that appeared unclear in the standard microscopic operative field covered with subarachnoid hemorrhage were extremely clearly depicted. These Sylvian ICG findings were helpful in identifying entry points and the dissecting course of the Sylvian fissure. At the time of clipping, no residual fluorescence from Sylvian ICG was present, and aneurysm clipping was not impeded. Sylvian ICG for SAH patients is a novel technique to facilitate dissection of the Sylvian fissure. We believe that this technique will contribute to improved safety of clipping surgery for ruptured aneurysms.

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“…Recently, the utility of indocyanine green video angiography for the SMCV dissection was reported. 27,42,43) Although the patterns of DMCVs were not investigated in detail in this study, opening the Sylvian fissure widely was sometimes obstructed by the DMCV. In such cases, the DMCVs or its branches should be dissected from the surrounding tissue as much as possible, and additional dissection of the SMCV, such as between the TST/TSV and the temporal lobe, may be required (Fig.…”

Section: Dissection Of a Type E Smcvmentioning

confidence: 87%

“…Recently, the utility of indocyanine green video angiography for the SMCV dissection was reported. 27 , 42 , 43) …”

Section: Discussionmentioning

confidence: 99%

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

Imada

Mihara

Kawamoto

et al. 2021

Neurol. Med. Chir.(Tokyo)

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The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.

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Indocyanine Green (ICG) Videoangiography-Guided Dissection of the Sylvian Fissure on the Transsylvian Approach: Technical Note

Cited by 11 publications

References 7 publications

Use of ICG videoangiography and FLOW 800 analysis to identify the patient-specific venous circulation and predict the effect of venous sacrifice: a retrospective study of 172 patients

Use of ICG videoangiography and FLOW 800 analysis to identify the patient-specific venous circulation and predict the effect of venous sacrifice: a retrospective study of 172 patients

Utility of Indocyanine Green Video Angiography for Sylvian Fissure Dissection in Subarachnoid Hemorrhage Patients - Sylvian ICG Technique

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

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