Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography

Januszewski, Jacob; Beecher, Jeffrey S.; Chalif, David J.; Dehdashti, Amir R.

doi:10.3171/2013.12.focus13473

Cited by 25 publications

(17 citation statements)

References 12 publications

(14 reference statements)

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“…In addition to headaches and local neurofunctional deficits, the most serious consequence of HS is intracranial hemorrhage 56 . The occurrence of HS-induced intracerebral hemorrhage is not rare after direct revascularization of MMD.…”

Section: Hs-induced Intracranial Hemorrhagementioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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Moyamoya disease (MMD) involves progressive occlusion of the intracranial internal carotid artery resulting in formation of moyamoya-like vessels at the base of the brain. It can be characterized by hemorrhage or ischemia. Direct vascular bypass is the main and most effective treatment of MMD. However, patients with MMD differ from those with normal cerebral vessels. MMD patients have unstable intracranial artery hemodynamics and a poor blood flow reserve; therefore, during the direct bypass of superficial temporal artery (STA)-middle cerebral artery (MCA) anastomosis, perioperative risk factors and anesthesia can affect the hemodynamics of these patients. When brain tissue cannot tolerate a high blood flow rate, it becomes prone to hyperperfusion syndrome, which leads to neurological function defects and can even cause intracranial hemorrhage in severe cases. The brain tissue is prone to infarction when hemodynamic equilibrium is affected. In addition, bypass vessels become susceptible to occlusion or atrophy when blood resistance increases. Even compression of the temporalis affects bypass vessels. Because the STA is used in MMD surgery, the scalp becomes ischemic and is likely to develop necrosis and infection. These complications of MMD surgery are difficult to manage and are not well understood. To date, no systematic studies of the complications that occur after direct bypass in MMD have been performed, and reported complications are hidden among various case studies; therefore, this paper presents a review and summary of the literature in PubMed on the complications of direct bypass in MMD.

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Section: Hs-induced Intracranial Hemorrhagementioning

confidence: 99%

Progress on Complications of Direct Bypass for Moyamoya Disease

Shi

Guo

et al. 2016

Int. J. Med. Sci.

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“…1,12 In particular, the use of intraoperative volumetric flow measurements and video-assisted indocyanine green (ICG), including the recent development of infrared local flow analysis, 16,17 have unequivocally shown their benefit. 2,5,13 This hemodynamic information, however, is only provided on a vascular level and gives no insight into the hemodynamic state at the brain tissue level, and it does not reveal changes in brain tissue perfusion immediately after bypass revascularization, especially in areas distant from the anastomosis. Therefore, it can only be assumed that the flow measured through the bypass graft is sufficient for the vascular territory downstream to maintain brain tissue function and integrity.…”

mentioning

confidence: 99%

Feasibility and safety of intraoperative BOLD functional MRI cerebrovascular reactivity to evaluate extracranial-to-intracranial bypass efficacy

Muscas

Niftrik

Fierstra

et al. 2019

Neurosurgical Focus

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Blood oxygenation level–dependent functional MRI cerebrovascular reactivity (BOLD-CVR) is a contemporary technique to assess brain tissue hemodynamic changes after extracranial- intracranial (EC-IC) bypass flow augmentation surgery. The authors conducted a preliminary study to investigate the feasibility and safety of intraoperative 3-T MRI BOLD-CVR after EC-IC bypass flow augmentation surgery. Five consecutive patients selected for EC-IC bypass revascularization underwent an intraoperative BOLD-CVR examination to assess early hemodynamic changes after revascularization and to confirm the safety of this technique. All patients had a normal postoperative course, and none of the patients exhibited complications or radiological alterations related to prolonged anesthesia time. In addition to intraoperative flow measurements of the bypass graft, BOLD-CVR maps added information on the hemodynamic status and changes at the brain tissue level. Intraoperative BOLD-CVR is feasible and safe in patients undergoing EC-IC bypass revascularization. This technique can offer immediate hemodynamic feedback on brain tissue revascularization after bypass flow augmentation surgery.

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“…In all of their cases, the type of flow observed through the graft was confirmed on postoperative imaging findings, and it was determined that ICG videoangiography is reliable to evaluate flow in cases of EC-IC or intracranial-intracranial (IC-IC) bypass for ischemic stroke [37].…”

Section: Applications In Cerebral Artery Bypass Surgerymentioning

confidence: 96%

Lighting Up Neurovascular Surgery

Krakauer¹,

Kalani²

2014

Cureus

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Patient care has been revolutionized by the introduction of fluorescent dyes and the incorporation of fluorescence technology in disciplines ranging from ophthalmology to neurovascular surgery. These technologies enable clinicians and surgeons to produce accurate and real-time images of difficult-to-see structures within the human body, providing a crucial step to not only understanding biological processes but also advancing treatments. Isosulfan blue, fluorescein, and 5-aminolevulinic acid have proven useful in multiple fields of medicine. Indocyanine green (ICG) is another key fluorescent dye. Combined with specialized intraoperative microscopes, it is ideal for vascular studies because it diffuses easily from vessels into the interstitial space. Ultimately, images of the vascular system within the surgical field can be observed on a video screen in real time. Today ICG allows neurosurgeons to evaluate the quality of an aneurysm clipping, the potential for residual flow in a fistula or malformation, and the patency of a bypass. With introduction of other dyes and improvements in imaging techniques, we are likely to see an expansion in application of fluorescent technology in neurosurgery and other fields, which will ultimately lead to better patient care and outcomes.

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Flow-based evaluation of cerebral revascularization using near-infrared indocyanine green videoangiography

Cited by 25 publications

References 12 publications

Progress on Complications of Direct Bypass for Moyamoya Disease

Progress on Complications of Direct Bypass for Moyamoya Disease

Feasibility and safety of intraoperative BOLD functional MRI cerebrovascular reactivity to evaluate extracranial-to-intracranial bypass efficacy

Lighting Up Neurovascular Surgery

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