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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Between 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>ICG-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.</jats:p></jats:sec>

Fluorescein Application in Cranial and Spinal Tumors Enhancing at Preoperative MRI and Operated With a Dedicated Filter on the Surgical Microscope: Preliminary Results in 279 Patients Enrolled in the FLUOCERTUM Prospective Study

“…On the contrary, we believe that a more appropriate application of fluorescein was proposed by Rey-Dios et al (37) for these tumor subtypes. They reported the intravenous administration of fluorescein in bolus immediately before tumor resection to better visualize its vascular network, including arterial feeders, draining veins, and the nodule, as similarly reported by our group with ICG video-angiography (48, 49) (Table 1).…”

Applications of Microscope-Integrated Indocyanine Green Videoangiography in Cerebral Revascularization Procedures

“…This technique may allow real-time intraoperative tumor identification to optimize surgical resection (65). Additionally, ICG-VA has been used to identify the venous drainage pattern and collateral circulations during tumor resection for possible venous sacrifice to predict and minimize the potential side effects (66). However, the role of these techniques in the setting of revascularization has yet to be elucidated.…”

Cardiac pulsatility mapping and vessel type identification using laser speckle contrast imaging

“…Incorrect identification of vessel type can lead to venous sacrifice which in turn can led to serious complications during surgeries [25][26][27], and thus, any additional information is valuable that helps a surgeon to make the right decision and possible early intervention. This becomes particularly important in pathologies which alter the vascular anatomy, making it difficult for a specialist to recognize vessel type [28]. In some cases, techniques like fluorescent videoangiography, high-resolution 3D and 4D magnetic resonance angiography and contrast-enhanced ultrasound angiography have been used to identify the vasculature [28,29].…”

“…This becomes particularly important in pathologies which alter the vascular anatomy, making it difficult for a specialist to recognize vessel type [28]. In some cases, techniques like fluorescent videoangiography, high-resolution 3D and 4D magnetic resonance angiography and contrast-enhanced ultrasound angiography have been used to identify the vasculature [28,29]. Some of these techniques cannot provide real-time intraoperative imaging or require injection of agents and/or use of sterile imaging probes that need to be positioned on the tissue many times to get consecutive images.…”