Intraoperative surveillance of the vertebral artery using indocyanine green angiography and Doppler sonography in craniovertebral junction surgeries

Abstract

OBJECTIVEThe authors sought to evaluate the usefulness of indocyanine green (ICG) angiography and Doppler sonography for monitoring the vertebral artery (VA) during craniovertebral junction (CVJ) surgery and compare the incidence of VA injury (VAI) between the groups with and without the monitoring of VA using ICG angiography and Doppler sonography.METHODSIn total, 344 consecutive patients enrolled who underwent CVJ surgery. Surgery was performed without intraoperative VA monitoring tools in 262 cases (control group) and with VA monitoring tools in 82 cases (monitoring group). The authors compared the incidence of VAI between groups. The procedure times of ICG angiography, change of VA flow velocity measured by Doppler sonography, and complication were investigated.RESULTSThere were 4 VAI cases in the control group, and the incidence of VAI was 1.5%. Meanwhile, there were no VAI cases in the monitoring group. The procedure time of ICG angiography was less than 5 minutes (mean [± SD] 4.6 ± 2.1 minutes) and VA flow velocity was 11.2 ± 4.5 cm/sec. There were several cases in which the surgical method had to be changed depending on the VA monitoring. The combined use of ICG angiography and Doppler sonography was useful not only to monitor VA patency but also to assess the quality of blood flow during CVJ surgery, especially in the high-risk group of patients.CONCLUSIONSThe combined use of ICG angiography and Doppler sonography enables real-time intraoperative monitoring of the VA by detecting blood flow and flow velocity. As the arteries get closer, they provide auditory and visual feedback to the surgeon. This real-time image guidance could be a useful tool, especially for high-risk patients and inexperienced surgeons, to avoid iatrogenic VAI during any CVJ surgery.

Terminologia Anatomica of the groove for vertebral artery: Pros and Cons

“…Lofrese et al suggested that an intraoperative ultrasound exam could help from damaging the VA [3], but their work was based on the GVA structure. Luckily, a modi ed work noticed that the VA has different routes [22], which the VA angiography and the doppler sonography should use together. The variable bony structures over the GVA can be another resistance of the TA using GVA, because of that the bony structure over the GVA can form into a canal.…”

Extracranial Jugular Foramen Schwannomas Treated with the Extreme Lateral Juxtacondylar Approach: Surgical Technique and Our Experience

“…The iatrogenic vascular injury is a serious complication with the potential to cause fatal bleeding, permanent neurological impairment, and even death. 26 We performed 2 evaluations of the blood flow in 2 different moments of surgery: one at the beginning to individuate the vascular structure position and another at the end, after manipulation, to quickly individuate an eventual vasospasm. In the suspect of vascular injury, irrigation with a papaverine solution is helpful to reduce vasospasm because of arterial manipulation.…”

Safety and Efficacy of Intraoperative Doppler Sonography-Assisted Cervical Pedicle Screw Fixation—A Retrospective Comparison with Conventional Pedicle Screw Implantation

“…Doppler sonography enables VA monitoring during screw placement and providing informative feedback to the surgeon. 41 So, inadequate lateral deviation of screw trajectory can be easily detected intraoperatively based on simultaneous auditory, visual, and tactile feedback when a screw is directed toward a transverse foramen during instrumentation. 42 Thus, the Doppler-assisted technique reduces the risk of VA injury.…”