scholarly journals Evaluation of Intranasal Flap Perfusion by Intraoperative Indocyanine Green Fluorescence Angiography

2018 ◽  
Vol 15 (6) ◽  
pp. 672-676 ◽  
Author(s):  
Mathew Geltzeiler ◽  
Ana Carolina Igami Nakassa ◽  
Meghan Turner ◽  
Pradeep Setty ◽  
George Zenonos ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Skull Base ◽  
Near Infrared ◽  
The Body ◽  
Fluorescence Angiography ◽  
Flap Necrosis ◽  
Endonasal Surgery ◽  
Mri Contrast ◽  
Postoperative Mri ◽  
Flap Perfusion

Abstract BACKGROUND Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study. METHODS ICG near-infrared fluorescence endoscopy was performed during endoscopic endonasal surgery for skull base tumors. Intraoperative and postoperative data were collected regarding enhancement of the flap body and pedicle. Fluorescence was rated qualitatively. Postoperatively, flap perfusion was evaluated via MRI-contrast enhancement in addition to clinical outcomes (cerebrospinal fluid leak and endoscopic flap appearance). RESULTS Thirty-eight patients underwent ICG fluorescence angiography. Both the body and pedicle enhanced in 20 patients (53%), while the pedicle only enhanced for 12 patients (32%), the body only for 3 (8%), and neither for 3 (8%). When both the pedicle and body enhanced with ICG, the rate of postoperative MRI contrast enhancement was 100% and the rate of flap necrosis was 0%. The sensitivity and specificity of flap pedicle ICG enhancement for predicting postoperative flap MRI enhancement were 97% and 67%, respectively. Two of 3 patients without enhancement developed flap necrosis. CONCLUSION ICG fluorescence angiography of intraoperative flap perfusion is feasible and correlates well with outcomes of postoperative MRI flap enhancement and flap necrosis. Additional study is needed to further refine the imaging technique and optimally characterize the clinical utility.

Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review

2021 ◽  
Author(s):  
Noah Shaikh ◽  
Daniel O'Brien ◽  
Chadi Makary ◽  
Meghan Turner
Keyword(s):  
Systematic Review ◽  
Indocyanine Green ◽  
Skull Base ◽  
Csf Leak ◽  
Cochrane Central Register ◽  
Flap Necrosis ◽  
Skull Base Reconstruction ◽  
Postoperative Mri ◽  
Postoperative Meningitis ◽  
Flap Perfusion

Abstract Objective This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap. Study Design The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications. Results Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI (p = 0.008) and CSF leak (p = 0.315) by Fisher's exact test. Conclusion The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis. Level of Evidence This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.

Indocyanine Green Fluorescence Angiography of the Transverse Cervical Arterial Supply to Clavicle Flaps: An Anatomical Study

2021 ◽  
pp. 019459982110004
Author(s):  
Pichtat Muangsiri ◽  
Rungkit Tanjapatkul ◽  
Papat Sriswadpong ◽  
Pojanan Jomkoh ◽  
Supasid Jirawatnotai
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Head And Neck Reconstruction ◽  
Green Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Cervical Artery ◽  
Indocyanine Green Fluorescence Angiography ◽  
Vascularized Bone ◽  
Transverse Cervical Artery

Objective To describe the anatomy of the transverse cervical artery and to prove its perfusion to the clavicle using indocyanine green fluorescence angiography as an alternative vascularized bone for head and neck reconstruction. Study Design Cadaveric dissection. Setting Anatomy lab. Methods Twenty-two necks and shoulders from 11 fresh-frozen cadavers were dissected. The transverse cervical artery diameter, length, emerging point, and the length of clavicle segment harvested were described. Photographic and near-infrared video recordings of the bone’s medial and longitudinal cut surfaces were taken prior to, during, and after indocyanine green injection. Results The transverse cervical artery originated from the thyrocervical trunk and emerged at the level of the medial one-third of the clavicle in 22 of 22 (100%) specimens. The average length of the pedicle was 3.6 cm (range, 2.2-4.4 cm), and the mean diameter was 2.5 mm (range, 1.8-3.4 mm). The harvested bone had a mean length of 5.1 cm (range, 4.3-5.8 cm). After injecting the indocyanine green, 22 of 22 (100%) specimens showed enhancement in the periosteum, bony cortex, and medulla. Conclusion The middle third of the clavicle can be reliably harvested as a vascularized bone with its perfusion solely from the transverse cervical artery pedicle, as shown by the near-infrared fluorescence imaging. The pedicle was sizable and constant in origin.

Influence of vessel stenosis on indocyanine green fluorescence intensity assessed by near-infrared fluorescence angiography

Surgery Today ◽  
2016 ◽  
Vol 47 (7) ◽  
pp. 877-882 ◽  
Author(s):  
Masaki Yamamoto ◽  
Hideaki Nishimori ◽  
Takashi Fukutomi ◽  
Takemi Handa ◽  
Kazuki Kihara ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Fluorescence Intensity ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Green Fluorescence ◽  
Near Infrared Fluorescence ◽  
Indocyanine Green Fluorescence ◽  
Vessel Stenosis

PROSPECTIVE EVALUATION OF SURGICAL MICROSCOPE–INTEGRATED INTRAOPERATIVE NEAR-INFRARED INDOCYANINE GREEN ANGIOGRAPHY DURING CEREBRAL ARTERIOVENOUS MALFORMATION SURGERY

Neurosurgery ◽  
2009 ◽  
Vol 65 (3) ◽  
pp. 456-462 ◽  
Author(s):  
Brendan D. Killory ◽  
Peter Nakaji ◽  
L. Fernando Gonzales ◽  
Francisco A. Ponce ◽  
Scott D. Wait ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Digital Subtraction ◽  
Arteriovenous Shunting ◽  
Icg Angiography ◽  
Normal Vessel ◽  
Vascular Neurosurgery ◽  
Postoperative Findings ◽  
Angiographic Findings

Abstract OBJECTIVE Microscope-integrated indocyanine green (ICG) fluorescence angiography is a novel technique in vascular neurosurgery with potential utility in treating arteriovenous malformations (AVMs). METHODS We analyzed the application of intraoperative ICG in 10 consecutive AVM surgeries for which surgical video was available. The ability to distinguish AVM vessels (draining veins, feeding and nidal arteries) from each other and from normal vessel was evaluated, and ICG angiographic findings were correlated with intra- and postoperative findings on digital subtraction angiography (DSA). RESULTS ICG angiography was found to be useful by the surgeon in 9 of 10 patients. In 8 patients, it helped to distinguish AVM vessels. In 3 of 4 patients undergoing a postresection injection, it demonstrated that there was no residual arteriovenous shunting. In 1 patient, it helped to identify a small AVM nidus that was otherwise inapparent within a hematoma. Intraoperative DSA showed residual AVM in 2 of 10 patients requiring further resection of AVM not visualized during surgery. CONCLUSION Microscope-integrated ICG angiography is a useful tool in AVM surgery. It can be used to distinguish AVM vessels from normal vessels and arteries from veins based on the timing of fluorescence with the dye. Our experience suggests that it is less useful with deep-seated lesions or when AVM vessels are not on the surface. ICG angiography complements rather than replaces DSA.

Use of Indocyanine Green and Fluorescence Angiography in Parathyroid Surgery: A Feasibility Study

2020 ◽  
pp. 155335062095643
Author(s):  
Christina Maser ◽  
Amanda H. Kohlbrenner ◽  
Rachel Dirks
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Parathyroid Tissue ◽  
Surrounding Tissue ◽  
Fluorescence Angiography ◽  
Clinical Settings ◽  
Capillary Networks ◽  
Nir Fluorescence ◽  
Parathyroid Adenomas ◽  
Control Study

Background. Indocyanine green (ICG) with near-infrared (NIR) fluorescence is an established method for assessing vascularity in various clinical settings. We hypothesized that parathyroid adenomas, with increased capillary networks, may demonstrate a fluorescence which could aid intraoperative identification and confirmation of the abnormal parathyroid tissue. Methods. This prospective case–control study compared patients with primary hyperparathyroidism undergoing parathyroidectomy (cases) to normal parathyroid in thyroidectomy patients (controls). After exposing the parathyroid gland, ICG was injected and the fluorescence of parathyroid and thyroid was recorded and graded in comparison to the surrounding tissue and vasculature (0 = nonfluorescent and 5 = vasculature). Results. The intensity of parathyroid fluorescence was more in cases (4 ± 2) than controls (2 ± 1) when graded intraoperatively ( P = .001). Thyroid fluorescence did not differ (3 vs 3, P = .072); however, parathyroid fluorescence was more intense than thyroid in cases (parathyroid = 4 ± 2 and thyroid = 3 ± 1, P = .018). Conclusions. ICG fluorescence in diseased parathyroid was more intense than normal parathyroid and thyroid, suggesting the ICG/NIR technology may be a useful intraoperative tool for identification of abnormal parathyroid.

scholarly journals Integration of Indocyanine Green Videoangiography With Operative Microscope: Augmented Reality for Interactive Assessment of Vascular Structures and Blood Flow

2015 ◽  
Vol 11 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Nikolay L Martirosyan ◽  
Jesse Skoch ◽  
Jeffrey R Watson ◽  
G Michael Lemole ◽  
Marek Romanowski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Real Time ◽  
Femoral Artery ◽  
White Light ◽  
Near Infrared ◽  
Field Of View ◽  
Fluorescence Angiography ◽  
Indocyanine Green Videoangiography ◽  
Operative Microscope

Abstract BACKGROUND Preservation of adequate blood flow and exclusion of flow from lesions are key concepts of vascular neurosurgery. Indocyanine green (ICG) fluorescence videoangiography is now widely used for the intraoperative assessment of vessel patency. OBJECTIVE Here, we present a proof-of-concept investigation of fluorescence angiography with augmented microscopy enhancement: real-time overlay of fluorescence videoangiography within the white light field of view of conventional operative microscopy. METHODS The femoral artery was exposed in 7 anesthetized rats. The dissection microscope was augmented to integrate real-time electronically processed near-infrared filtered images with conventional white light images seen through the standard oculars. This was accomplished by using an integrated organic light-emitting diode display to yield superimposition of white light and processed near-infrared images. ICG solution was injected into the jugular vein, and fluorescent femoral artery flow was observed. RESULTS Fluorescence angiography with augmented microscopy enhancement was able to detect ICG fluorescence in a small artery of interest. Fluorescence appeared as a bright-green signal in the ocular overlaid with the anatomic image and limited to the anatomic borders of the femoral artery and its branches. Surrounding anatomic structures were clearly visualized. Observation of ICG within the vessel lumens permitted visualization of the blood flow. Recorded video loops could be reviewed in an offline mode for more detailed assessment of the vasculature. CONCLUSION The overlay of fluorescence videoangiography within the field of view of the white light operative microscope allows real-time assessment of the blood flow within vessels during simultaneous surgical manipulation. This technique could improve intraoperative decision making during complex neurovascular procedures.

Evaluation of Serial Intraoperative Surgical Microscope-Integrated Intraoperative Near-Infrared Indocyanine Green Videoangiography in Patients With Cerebral Arteriovenous Malformations

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons34-ons43 ◽  
Author(s):  
Yasushi Takagi ◽  
Keiko Sawamura ◽  
Nobuo Hashimoto ◽  
Susumu Miyamoto
Keyword(s):  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Arteriovenous Malformations ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Digital Subtraction ◽  
Cerebral Arteriovenous Malformations ◽  
Viable Option ◽  
Indocyanine Green Videoangiography ◽  
Surgical Microscope

Abstract BACKGROUND: With the use of indocyanine green (ICG) as a novel fluorescent dye, fluorescence angiography has recently reemerged as a viable option. OBJECTIVE: To show the result of ICG videoangiography in cases of cerebral arteriovenous malformations. METHODS: Twenty-seven ICG videoangiography procedures were performed in 11 patients with cerebral arteriovenous malformations. Intraoperative digital subtraction angiography (DSA) was performed 27 times in these patients. The timing of intraoperative DSA was before dissection, after clipping of feeders, and after dissection of the nidus. RESULTS: The procedures were performed in 4.7 ± 1.4 minutes (mean ± SD; n = 27 minutes), whereas intraoperative digital subtraction angiography was performed for a mean of 16.6 ± 3.8 minutes (n = 27 minutes). In predissection studies, feeders were visualized by ICG in 3 of 9 cases. The nidus was visualized in all 9 cases, and drainers were visualized in 8. Intraoperative DSA visualized the feeders, nidus, and drainers in all 9 cases. After clipping of feeders, ICG videoangiography showed flow reduction of the nidus in 7 of 7 cases. Intraoperative DSA also showed that finding in 9 of 9 cases. After total dissection of the nidus, all cases disclosed that the drainers were without ICG filling. Intraoperative DSA also showed that result in all of the cases. Unexpected residual nidus was not visualized in our series with either method. CONCLUSION: We found that ICG videoangiography is helpful for resecting cerebral arteriovenous malformation. It is especially effective in visualizing the nidus and superficial drainers, as well as changes in flow after clipping or coagulating of feeders.

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