Venous sacrifice in neurosurgery: new insights from venous indocyanine green videoangiography

2011 ◽  
Vol 115 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Paolo Ferroli ◽  
Francesco Acerbi ◽  
Giovanni Tringali ◽  
Erminia Albanese ◽  
Morgan Broggi ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Collateral Circulation ◽  
Flow Direction ◽  
Flow Dynamics ◽  
Neurosurgical Procedures ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Specific Test ◽  
Time Flow ◽  
Anastomotic Circulation

Object The purpose of this paper is to evaluate whether venous indocyanine green (ICG) videoangiography has any potential for predicting the presence of a safe collateral circulation for veins that are at risk for intentional or unintentional damage during surgery. Methods The authors performed venous ICG videoangiography during 153 consecutive neurosurgical procedures. On those occasions in which a venous sacrifice occurred during surgery, whether that sacrifice was preplanned (intended) or unintended, venous ICG videoangiography was repeated so as to allow us to study the effect of venous sacrifice. A specific test to predict the presence of venous collateral circulation was also applied in 8 of these cases. Results Venous ICG videoangiography allowed for an intraoperative real-time flow assessment of the exposed veins with excellent image quality and resolution in all cases. The veins observed in this study were found to be extremely different with respect to flow dynamics and could be divided in 3 groups: 1) arterialized veins; 2) fast-draining veins with uniform filling and clear flow direction; and 3) slow-draining veins with nonuniform filling. Temporary clipping was found to be a simple and reversible way to test for the presence of potential anastomotic circulation. Conclusions Venous ICG videoangiography is able to reveal substantial variability in the venous flow dynamics. “Slow veins,” when they are tributaries of bridging veins, might hide a potential for anastomotic circulation that deserve further investigation.

scholarly journals Blood Flow Assessment of Arteriovenous Malformations Using Intraoperative Indocyanine Green Videoangiography

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Naoki Kato ◽  
Vincent Prinz ◽  
Julius Dengler ◽  
Peter Vajkoczy
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Indocyanine Green ◽  
Region Of Interest ◽  
Flow Dynamics ◽  
Flow Index ◽  
Indocyanine Green Videoangiography ◽  
Blood Flow Index ◽  
High Resolution Images ◽  
The Individual

Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.

Importance of collateral venous circulation on indocyanine green videoangiography in intracranial meningioma resection: direct evidence for venous compression theory in peritumoral edema formation

2020 ◽  
Vol 132 (6) ◽  
pp. 1715-1723
Author(s):  
Ju-Hwi Kim ◽  
Kyung-Sub Moon ◽  
Ji-Ho Jung ◽  
Woo-Youl Jang ◽  
Tae-Young Jung ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Standard Dose ◽  
Tumor Resection ◽  
Intracranial Meningioma ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Excitation Light ◽  
Venous Circulation ◽  
Flow Restoration ◽  
Venous Collaterals

OBJECTIVEIndocyanine green videoangiography (ICGVA) has been used in many neurosurgical operations, including vascular and brain tumor fields. In this study, the authors applied ICGVA to intracranial meningioma surgery and evaluated it usefulness with attention to collateral venous flow.METHODSForty-two patients with intracranial meningioma who underwent ICGVA during microsurgical resection were retrospectively analyzed. For ICGVA, the ICG was injected intravenously at the standard dose of 12.5 mg before and/or after tumor resection. Intravascular fluorescence from blood vessels was imaged through a microscope with a special filter and infrared excitation light to illuminate the operating field. The authors assessed the benefits of ICGVA and analyzed its findings with preoperative radiological findings on MRI.RESULTSICGVA allowed real-time assessment of the patency and flow direction in very small peritumoral vessels in all cases. A safe dural incision could also be done based on information from ICGVA. The collateral venous channel due to venous obstruction of tumoral compression was found in 10 cases, and venous flow restoration after tumor resection was observed promptly after tumor resection in 4 cases. Peritumoral brain edema (PTBE) was observed on preoperative T2-weighted MRI in 19 patients. The presence of collateral venous circulation or flow restoration was significantly related to PTBE formation in multivariate analysis (p = 0.001; HR 0.027, 95% CI 0.003–0.242).CONCLUSIONSICGVA, an excellent method for monitoring blood flow during meningioma resection, provides valuable information as to the presence of venous collaterals and flow restoration. Furthermore, the fact that the presence of venous collaterals was found to be associated with PTBE may directly support the venous theory as the pathogenesis of PTBE formation.

Abstract 131: Methods Behind Thrombus Size Variability in Murine IVC Ligation Model Revealed: Insights From MRI

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Olivia R Palmer ◽  
Jose A Diaz ◽  
Joan M Greve
Keyword(s):  
Blood Flow ◽  
Flow Direction ◽  
Flow Dynamics ◽  
Variation Coefficient ◽  
Mri Findings ◽  
Venous Flow ◽  
Vein Thrombosis ◽  
Blood Flow Dynamics ◽  
Size Variability ◽  
Collateral Vessels

Objectives: Animal models are key tools for studying deep vein thrombosis (VT). Variation in thrombus size is a current concern that limits the ability to detect small differences between experimental groups. Our objective is to understand the mechanism of this variation. We hypothesized that thrombus size variability results from altered flow dynamics involving venous branches. Using MRI, we investigated the path of blood flow in the murine IVC ligation model. Methods: VT was induced in 11-15 week-old C57BL/6 mice (n=9) via IVC ligation with either interruption of all venous branches (IB), or all branches left open (OB). Mice were imaged by MRI 2 days post ligation to examine IVC patency and/or presence of thrombus. Venous flow was saturated to determine venous branching phenotype and flow direction, which was compared to pre-surgical MRI. Then, axial slices were acquired from the renal to iliac vessels to quantify thrombus volume. Finally, thrombus weight (TW) was quantified at harvest. Results: MRI: Thrombus volumes were larger in IB mice compared to OB mice (38.0 ± 4.6 mm 3 IB vs. 11.3 ± 8.3 mm 3 OB), with greater variability in OB mice (variation coefficient 12% IB vs. 73% OB). Open branches had great impact on reducing TW due to reversed flow direction, increasing thrombus size variability. IB mice showed flow compensation through the vertebral veins and collateral vessels. At harvest: TWs confirmed MRI findings (34.5 ± 3.8 mg IB vs. 15.7 ± 9.8 mg OB; variation coefficient 11% IB vs. 62% OB). The pattern of 2 back branches was observed in all mice, and 1 right branch was the most common phenotype. The OB mouse with the highest TW had 2 side branches, whereas the other OB mice had 1 right branch only. Conclusion: Thrombus size variability increased when branches were not interrupted. Blood flow dynamics detected by MRI were critical for understanding the “flow escape phenomenon” from the IVC that occurs through branches when they are left open. This study supports that the anatomical branching pattern affects blood flow in the IVC. Non-invasive MRI brings to light the important role of venous branches inducing thrombus variability in VT models.

scholarly journals 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

2018 ◽  
Vol 45 (1) ◽  
pp. E7 ◽  
Author(s):  
Francesco Acerbi ◽  
Ignazio G. Vetrano ◽  
Tommaso Sattin ◽  
Jacopo Falco ◽  
Camilla de Laurentis ◽  
...  
Keyword(s):  
Flow Direction ◽  
Flow Characteristics ◽  
Venous Drainage ◽  
Extent Of Resection ◽  
Patient Specific ◽  
Drainage Pattern ◽  
Indocyanine Green Videoangiography ◽  
Venous Flow ◽  
Venous Circulation ◽  
Flow 800

OBJECTIVEThe 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.METHODSBetween 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.RESULTSA 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.CONCLUSIONSICG-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.

scholarly journals Can the Efficacy of Indocyanine Green Videoangiography in Cerebral Arterio-Venous Malformations Surgery Be Further Improved?

Neurosurgery ◽  
2014 ◽  
Vol 75 (6) ◽  
pp. E732-E734 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Renato Scienza ◽  
Oriela Rustemi ◽  
Giorgio Gioffré
Keyword(s):  
Indocyanine Green ◽  
Venous Malformations ◽  
Indocyanine Green Videoangiography
Sign in / Sign up

Export Citation Format

Share Document