Intraoperative control of extracranial—intracranial bypass patency by near-infrared indocyanine green videoangiography

2005 ◽  
Vol 102 (4) ◽  
pp. 692-698 ◽  
Author(s):  
Johannes Woitzik ◽  
Peter Horn ◽  
Peter Vajkoczy ◽  
Peter Schmiedek
Keyword(s):  
Indocyanine Green ◽  
Ct Angiography ◽  
Bypass Surgery ◽  
Near Infrared ◽  
Bypass Graft ◽  
High Flow ◽  
Indocyanine Green Videoangiography ◽  
Content Type ◽  
Bypass Patency ◽  
Fine Print

Object. Recently, intraoperative fluorescence angiography in which indocyanine green (ICG) is used as a tracer has been introduced as a novel technique to confirm successful aneurysm clipping. The aim of the present study was to assess whether ICG videoangiography is also suitable for intraoperative confirmation of extracranial—intracranial bypass patency. Methods. Forty patients undergoing cerebral revascularization for hemodynamic cerebral ischemia (11 patients), moyamoya disease (18 patients), or complex intracranial aneurysms (11 patients) were included. Superficial temporal artery (STA)—middle cerebral artery (MCA) bypass surgery was performed 35 times in 30 patients (five patients with moyamoya underwent bilateral procedures), STA—posterior cerebral artery bypass surgery in two patients, and saphenous vein (SV) high-flow bypass surgery in eight patients. In each patient, following the completion of the anastomosis, ICG (0.3 mg/kg body weight) was given systemically via an intravenous bolus injection. A near-infrared light emitted by laser diodes was used to illuminate the operating field and the intravascular fluorescence was recorded using an optical filter—equipped video camera. The findings of ICG videoangiography were compared with those of postoperative digital subtraction (DS) or computerized tomography (CT) angiography. In all cases excellent visualization of cerebral arteries, the bypass graft, and brain perfusion was noted. Indocyanine green videoangiography was used to identify four nonfunctioning STA—MCA bypasses, which could be revised successfully in all cases. In two cases of SV high-flow bypasses, ICG videoangiography revealed stenosis at the proximal anastomotic site, which was also revised successfully. In all cases the final findings of ICG videoangiography could be positively validated during the postoperative course by performing DS or CT angiography. Conclusions. Indocyanine green videoangiography provides a reliable and rapid intraoperative assessment of bypass patency. Thus, ICG videoangiography may help reduce the incidence of early bypass graft failure.

Prospective evaluation of surgical microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery

2005 ◽  
Vol 103 (6) ◽  
pp. 982-989 ◽  
Author(s):  
Andreas Raabe ◽  
Peter Nakaji ◽  
Jürgen Beck ◽  
Louis J. Kim ◽  
Frank P. K. Hsu ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Video Camera ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Significant Information ◽  
Excitation Light ◽  
Content Type ◽  
Surgical Microscope ◽  
Fine Print

Object. The authors prospectively compared a new technique of surgical microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating microscope (Carl Zeiss Co., Oberkochen, Germany). A microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with intra- or postoperative DS angiography in 90% of cases. The ICG technique missed mild but hemodynamically irrelevant stenosis that was evident on DS angiography in 7.3% of cases. The ICG technique missed angiographically relevant findings in three cases (one hemodynamically relevant stenosis and two residual aneurysm necks [2.7% of cases]). In two cases the missed findings were clinically and surgically inconsequential; in the third case, a 4-mm residual neck may require a second procedure. Indocyanine green videoangiography provided significant information for the surgeon in 9% of cases, most of which led to clip correction. Conclusions. Microscope-based ICG videoangiography is simple and provides real-time information about the patency of vessels of all sizes and about the aneurysm sac. This technique may be useful during routine aneurysm surgery as an independent form of angiography or as an adjunct to intra- or postoperative DS angiography.

Evaluation of extracranial—intracranial arterial bypass function by using near-infrared spectroscopy

2003 ◽  
Vol 99 (2) ◽  
pp. 304-310 ◽  
Author(s):  
Yoshihiro Murata ◽  
Yoichi Katayama ◽  
Kaoru Sakatani ◽  
Chikashi Fukaya ◽  
Tsuneo Kano
Keyword(s):  
Infrared Spectroscopy ◽  
Near Infrared Spectroscopy ◽  
Sensorimotor Cortex ◽  
Bypass Surgery ◽  
Near Infrared ◽  
Cutoff Value ◽  
Content Type ◽  
Arterial Bypass ◽  
Group Iii ◽  
Fine Print

Object. It has been reported that extracranial—intracranial (EC—IC) arterial bypass surgery can be useful in preventing stroke in patients with hemodynamic compromise. Little is yet known, however, regarding the extent to which the bypass contributes to maintaining adequate cerebral blood oxygenation (CBO) and its temporal changes following surgery. The authors evaluated bypass function repeatedly by using near-infrared spectroscopy (NIRS) after surgery. Methods. The authors investigated 30 patients who had undergone EC—IC bypass surgery. Single-photon emission computerized tomography revealed a decrease in regional cerebral blood flow (rCBF) and a lowered rCBF response to acetazolamide. Changes in CBO were evaluated in the sensorimotor cortex during compression of the anastomosed superficial temporal artery (STA). When decreases in oxyhemoglobin (HbO2) and total hemoglobin (Hb) concentrations were observed, the bypass was considered to have maintained CBO in the sensorimotor cortex given that decreases in HbO2 and total Hb indicate cerebral ischemic changes. The bypass maintained CBO immediately after surgery in 36.7% of patients (Group I, 11 patients) and at some time after surgery, mostly within 1 year, in 43.3% of patients (Group II, 13 patients); however, it did not maintain it throughout the follow-up period in 20% of patients (Group III, six patients). Note that the preoperative rCBF in patients in Groups I and II was lower than that in patients in Group III (p < 0.004). In fact, the preoperative rCBF predicted whether a bypass would maintain CBO at a cutoff value of 24.5 to 25 ml/100 g/min. Among Groups I and II, 18 patients demonstrated an increase in deoxyhemoglobin during STA compression. The preoperative rCBF in these cases was lower than that in the six remaining patients (p < 0.006). Note that the preoperative rCBF predicted the postoperative deoxyhemoglobin response at a cutoff value of 22.2 to 24 ml/100 g/min. Conclusions. The EC—IC bypass surgery can maintain CBO immediately after surgery or gradually within 1 year when the preoperative rCBF is below 24.5 to 25 ml/100 g/min. Furthermore, bypass flow plays a critical role in maintaining an adequate CBO when preoperative rCBF is below 22.2 to 24 ml/100 g/min.

Use of an intracranial near-infrared probe for localization during stereotactic surgery for movement disorders

2000 ◽  
Vol 93 (3) ◽  
pp. 498-505 ◽  
Author(s):  
Cole A. Giller ◽  
Maureen Johns ◽  
Hanli Liu
Keyword(s):  
White Matter ◽  
Gray Matter ◽  
Movement Disorders ◽  
Near Infrared ◽  
Subcortical White Matter ◽  
Stereotactic Surgery ◽  
Resected Specimen ◽  
Subcortical Structures ◽  
Content Type ◽  
Fine Print

✓ Localization of targets during stereotactic surgery is frequently accomplished by identification of the boundaries between the gray matter of various nuclei and the surrounding white matter. The authors describe an intracranial probe developed for this purpose, which uses near-infrared (NIR) light.The probe fits through standard stereotactic holders and emits light at its tip. The scattered light is detected and analyzed by a spectrometer, with the slope of the trailing portion of the reflectance curve used as the measurement value.Near-infrared readings were obtained during 27 neurosurgical procedures. The first three operations were temporal lobectomies, with values obtained from tracks in the resected specimen and resection bed. In the next five procedures, the probe was inserted stereotactically to a depth of 1 to 2 cm with measurements obtained every 1 mm. The probe was then used in 19 stereotactic procedures for movement disorders, obtaining measurements every 0.5 to 1 mm to target depths of 6 to 8 cm to interrogate subcortical structures. The NIR signals were correlated to distances beneath the cortical surface measured on postoperative computerized tomography or magnetic resonance imaging by using angle correction and three-dimensional reconstruction techniques.The NIR values for white and gray matter obtained during the lobectomies were significantly different (white matter 2.5 ± 0.37, gray matter 0.82 ± 0.23 mean ± standard deviation). The NIR values from the superficial stereotactic tracks showed initial low values corresponding to cortical gray matter and high values corresponding to subcortical white matter.There was good correlation between the NIR signals and postoperative imaging in the 19 stereotactic cases. Dips due to adjacent sulci, a plateau of high signal due to subcortical white matter, a dip in the NIR signal during passage through the ventricle, dips due to the caudate nucleus, and peaks due to the white matter capsule between ventricle and thalamus were constant features. The putamen—capsule boundary and the lamina externa and interna of the globus pallidus could be distinguished in three cases. Elevated signals corresponding to the thalamic floor were seen in 10 cases. Nuances such as prior lesions and nonspecific white matter changes were also detected. There was no incidence of morbidity associated with use of the probe. Data acquisition was straightforward and the equipment required for the studies was inexpensive.The NIR probe described in this article seems to be able to detect gray—white matter boundaries around and within subcortical structures commonly encountered in stereotactic functional neurosurgery. This simple, inexpensive method deserves further study to establish its efficacy for stereotactic localization.

Superficial temporal-middle cerebral artery bypass

1979 ◽  
Vol 51 (4) ◽  
pp. 455-465 ◽  
Author(s):  
Richard E. Latchaw ◽  
James I. Ausman ◽  
Myoung C. Lee
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Collateral Circulation ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Change Over Time ◽  
Content Type ◽  
Over Time ◽  
Fine Print ◽  
Temporal Middle

✓ Pre- and postoperative angiograms on 40 patients undergoing superficial temporal-middle cerebral artery (STA-MCA) bypass surgery have been examined in detail. Multiple postoperative angiograms have been obtained to evaluate the change in both the bypass circuit and the intracranial circulation over time. A reproducible system for evaluating the degree of intracranial vascular filling via the bypass is introduced. The study shows that the STA and its anastomotic branch increase in size over time, measured in months, in the majority of patients. This is paralleled by a progressive increase in the degree of intracranial vascular filling. These changes are proportional to the severity of the vascular disease before surgery. The pattern of preoperative collateral circulation may change over time following the addition of the bypass circuit. The progressive change over time suggests that a static analysis at one time may belie the true effect of the surgery. The change of collateral circulation, with augmentation of blood supply to areas of the brain other than those affected by the recent ischemic event, means that a total cerebral evaluation including neuropsychological testing may be necessary for adequate evaluation of the effect of the bypass surgery.

Defining thresholds for critical ischemia by using near-infrared spectroscopy in the adult brain

1998 ◽  
Vol 89 (3) ◽  
pp. 389-394 ◽  
Author(s):  
Peter J. Kirkpatrick ◽  
Joseph Lam ◽  
Pippa Al-Rawi ◽  
Piotr Smielewski ◽  
Marek Czosnyka
Keyword(s):  
Infrared Spectroscopy ◽  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Near Infrared Spectroscopy ◽  
Near Infrared ◽  
Adult Brain ◽  
Content Type ◽  
Signal Changes ◽  
Fine Print

Object. Signal changes in adult extracranial tissues may have a profound effect on cerebral near-infrared spectroscopy (NIRS) measurements. During carotid surgery NIRS signals provide the opportunity to determine the relative contributions from the intra- and extracranial vascular territories, allowing for a more accurate quantification. In this study the authors applied multimodal monitoring methods to patients undergoing carotid endarterectomy and explored the hypothesis that NIRS can define thresholds for cerebral ischemia, provided extracranial NIRS signal changes are identified and removed. Relative criteria for intraoperative severe cerebral ischemia (SCI) were applied to 103 patients undergoing carotid endarterectomy. Methods. One hundred three patients underwent carotid endarterectomy. An intraoperative fall in transcranial Doppler—detected middle cerebral artery flow velocity (%ΔFV) of greater than 60% accompanied by a sustained fall in cortical electrical activity were adopted as criteria for SCI. Ipsilateral frontal NIRS recorded the total difference in concentrations of oxyhemoglobin and deoxyhemoglobin (Total ΔHbdiff). Interrupted time series analysis following clamping of the external carotid artery (ECA) and the internal carotid artery (ICA) allowed the different vascular components of Total ΔHbdiff (ECA ΔHbdiff and ICA ΔHbdiff) to be identified. Data obtained in 76 patients were deemed suitable. A good correlation between %ΔFV and ICA ΔHbdiff (r = 0.73, p < 0.0001) was evident. Sixteen patients (21%) fulfilled the criteria for SCI. All patients who demonstrated an ICA ΔHbdiff of greater than 6.8 µmol/L showed SCI, and in two patients within this group nondisabling watershed infarction developed, as seen on postoperative computerized tomography scans. No patient with an ICA ΔHbdiff less than 5 µmol/L exhibited SCI or suffered a stroke. Within the resolution of the criteria used an ICA ΔHbdiff threshold of 6.8 µmol/L provided 100% specificity for SCI, whereas an ICA ΔHbdiff less than 5 µmol/L was 100% sensitive for excluding SCI. When Total ΔHbdiff was used without removing the ECA component, no thresholds for SCI were apparent. Conclusions. Carotid endarterectomy provides a stable environment for exploring NIRS-quantified thresholds for SCI in the adult head.

Novel Software-Derived Workflow in Extracranial–Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography

2020 ◽  
Vol 134 ◽  
pp. e892-e902
Author(s):  
Philippe Dodier ◽  
Thomas Auzinger ◽  
Gabriel Mistelbauer ◽  
Wei-Te Wang ◽  
Heber Ferraz-Leite ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Bypass Surgery ◽  
Indocyanine Green Videoangiography

scholarly journals Quantitative Analysis of Near-Infrared Indocyanine Green Videoangiography for Predicting Functional Outcomes After Spinal Intramedullary Ependymoma Resection

2019 ◽  
Vol 17 (5) ◽  
pp. 531-539 ◽  
Author(s):  
Hironori Arima ◽  
Kentaro Naito ◽  
Toru Yamagata ◽  
Shinichi Kawahara ◽  
Kenji Ohata ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Quantitative Analysis ◽  
Indocyanine Green ◽  
Functional Outcomes ◽  
Near Infrared ◽  
Peak Time ◽  
Functional Grade ◽  
Indocyanine Green Videoangiography ◽  
Peak Intensity ◽  
Ventral Spinal Cord

Abstract BACKGROUND One of the most critical steps in surgery for spinal intramedullary ependymomas is the resection of small feeding arteries from the anterior spinal artery with anatomical preservation of the normal circulation of the ventral spinal cord. OBJECTIVE To quantitatively analyze the microcirculation of the ventral spinal cord by near-infrared indocyanine green videoangiography (ICG-VA) after the spinal intramedullary ependymoma resection. METHODS This retrospective study included 12 patients (7 male and 5 female; average age 55.2 years, range 36-79 years). Patients’ neurological conditions were assessed based on the modified McCormick functional schema of grade 1 (neurologically normal) to 5 (severe deficit). Postoperative functional assessment was conducted at least 3 months after surgery. Quantitative analysis of vascular flow dynamics was carried out following spinal intramedullary ependymoma resection. Fluorescence intensities were measured and the indocyanine green (ICG) intensity-time curves were analyzed and compared with the functional outcomes after surgery. RESULTS Microscopically total or subtotal resection of the intramedullary ependymoma was achieved in all cases. Average peak time on ICG-VA was significantly shorter in the postoperative functional grade 1 to 2 group than in the postoperative functional grade 3 to 5 group, but there was no significant difference in average peak intensity between the 2 groups. Postoperative functional grade and the peak time of ICG, but not peak intensity, appeared correlated. CONCLUSION To the best of our knowledge, this is the first report showing that quantitative analysis of ICG-VA may predict functional outcomes after spinal intramedullary ependymoma resection.

Extracranial-intracranial arterial bypass for middle cerebral artery stenosis and occlusion

1985 ◽  
Vol 62 (6) ◽  
pp. 831-838 ◽  
Author(s):  
Brian T. Andrews ◽  
Norman L. Chater ◽  
Philip R. Weinstein
Keyword(s):  
Middle Cerebral Artery ◽  
Cerebral Artery ◽  
Slight Reduction ◽  
Content Type ◽  
Perioperative Stroke ◽  
Arterial Bypass ◽  
Mca Occlusion ◽  
Bypass Patency ◽  
Completed Stroke ◽  
Fine Print

✓ Forty-seven patients with middle cerebral artery (MCA) stenosis and 18 patients with MCA occlusion underwent extracranial-intracranial arterial bypass procedures. Patients presented with a history of transient ischemic attacks (TIA's), reversible ischemic neurological deficits, TIA's after initial stroke, stroke-in-evolution, or completed stroke. Angiography revealed that the MCA stenosis ranged from 70% to over 95%. Two patients (4.3%) in the stenosis group had a perioperative stroke (within 30 days of operation). There was no perioperative mortality. In the occlusion group, no patient had a perioperative stroke, and one patient (5.5%) died from a non-neurological disease. The TIA's resolved completely in 90% of the patients with stenosis and in 91.6% of those with occlusion. No patient with MCA stenosis had a late ipsilateral stroke, although five had a contralateral or vertebrobasilar stroke. One patient with MCA occlusion had a late ipsilateral stroke. The bypass patency rate at late follow-up review was 100%. The results of intracranial-extracranial arterial bypass procedures appear to be similar for patients with either stenosis or occlusion of the MCA. Symptomatic relief of TIA's was excellent and, in two patients with progressive stroke-in-evolution, the deficit was stabilized. The incidence of postoperative ipsilateral stroke was low in patients with TIA's alone or with TIA's after an initial stroke, but among patients with completed stroke, improvement was confined to slight reduction in the neurological deficit.

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