scholarly journals Influence of indocyanine green angiography on microsurgical treatment of spinal perimedullary arteriovenous fistulas

2016 ◽  
Vol 40 (3) ◽  
pp. E10 ◽  
Author(s):  
Keisuke Takai ◽  
Hiroki Kurita ◽  
Takayuki Hara ◽  
Kensuke Kawai ◽  
Makoto Taniguchi
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Surgical Procedure ◽  
Indocyanine Green Angiography ◽  
Endovascular Embolization ◽  
Surgical Strategy ◽  
Complete Occlusion ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Before And After

OBJECTIVE The microvascular anatomy of spinal perimedullary arteriovenous fistulas (AVFs) is more complicated than that of dural AVFs, and occlusion rates of AVF after open microsurgery or endovascular embolization are lower in patients with perimedullary AVFs (29%–70%) than they are in those with dural AVF (97%–98%). Reports of intraoperative blood flow assessment using indocyanine green (ICG) video angiography in spinal arteriovenous lesions have mostly been for spinal dural AVFs. No detailed reports on spinal perimedullary AVFs are available. METHODS Participants were 11 patients with spinal perimedullary AVFs (Type IVa in 5 patients, Type VIb in 4, and Type IVc in 2). Intraoperative ICG video angiography was assessed by measuring the number of cases in which this modality was judged essential by the surgeon to correctly occlude the fistula. RESULTS In all patients, arterial feeders were identified and intravenous ICG video angiography was performed before and after blocking the feeders. In one patient, selective intraarterial ICG video angiography was also performed. The findings provided by ICG video angiography significantly changed the surgical procedure in 4 of 11 patients (36%). Postoperatively, complete occlusion of the AVF was achieved in 10 of the 11 patients (91%). CONCLUSIONS Intraoperative ICG video angiography can have a significant impact on deciding surgical strategy in the microsurgical treatment of spinal perimedullary AVF.

Minimally invasive tubular retractor system for adequate exposure during surgical obliteration of spinal dural arteriovenous fistulas with the aid of indocyanine green intraoperative angiography

2012 ◽  
Vol 17 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Atman Desai ◽  
Kimon Bekelis ◽  
Kadir Erkmen
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Successful Treatment ◽  
Indocyanine Green Angiography ◽  
Intraoperative Angiography ◽  
Tubular Retractor ◽  
Microsurgical Treatment ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Spinal Dural Arteriovenous Fistulas

Effective surgical obliteration of spinal dural arteriovenous fistulas (DAVFs) traditionally requires laminectomy or hemilaminectomy to allow intradural exposure and occlusion of the draining vein. The authors present successful treatment of a spinal DAVF by using a tubular retractor system to provide minimally invasive exposure at the L5–S1 level adequate for both microsurgical treatment and intraoperative indocyanine green angiography.

Intraoperative indocyanine green angiography for obliteration of a spinal dural arteriovenous fistula

2009 ◽  
Vol 11 (6) ◽  
pp. 705-709 ◽  
Author(s):  
Geoffrey P. Colby ◽  
Alexander L. Coon ◽  
Daniel M. Sciubba ◽  
Ali Bydon ◽  
Philippe Gailloud ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Vascular Anatomy ◽  
Endovascular Embolization ◽  
Spinal Dural Arteriovenous Fistula ◽  
Lower Extremity Weakness ◽  
Spinal Arteriovenous Malformation ◽  
Arteriovenous Fistulas ◽  
Icg Angiography ◽  
Clip Occlusion ◽  
Vascular Neurosurgery

Spinal dural arteriovenous fistulas (DAVFs) are the most common type of spinal arteriovenous malformation and are an important, underdiagnosed cause of progressive myelopathy and morbidity in patients with spine disorders. Successful microsurgical management of these lesions is dependent on the surgeon's ability to identify vessels of the fistula and to confirm its successful obliteration postintervention. Indocyanine green (ICG) fluorescent angiography is an emerging tool for delineating intraoperative vascular anatomy, and it has significant potential utility in the treatment of vascular disease in the spine. The authors present the case of a 76-year-old man with progressive and debilitating bilateral lower-extremity weakness and numbness on exertion, in whom a left T-8 spinal DAVF was diagnosed based on results of conventional spinal angiography. Unfavorable anatomy based on angiographic findings precluded endovascular embolization of the fistula, and the patient subsequently underwent T7–9 bilateral laminectomies for microsurgical clip occlusion. Intraoperative ICG fluorescent angiography was used before clip placement to identify the arterialized veins of the fistula, and after clip placement to confirm obliteration of the fistulous connection and restoration of normal blood flow. Intraoperative ICG angiography serves an important role in the microsurgical treatment of DAVF. It can be used to map the anatomy of the fistula in real time during surgery and to verify fistula obliteration rapidly after clip placement. This report adds to the growing body of literature demonstrating the importance of ICG angiography in vascular neurosurgery of the spine.

Intraoperative EC-IC Bypass Blood Flow Assessment With Indocyanine Green Angiography in Moyamoya and Non-Moyamoya Ischemic Stroke

2010 ◽  
Vol 73 (6) ◽  
pp. 668-674 ◽  
Author(s):  
Takayuki Awano ◽  
Kaoru Sakatani ◽  
Noriaki Yokose ◽  
Yuko Kondo ◽  
Takahiro Igarashi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Ischemic Stroke ◽  
Indocyanine Green ◽  
Indocyanine Green Angiography

scholarly journals Automated Quantitative Analysis of Blood Flow in Extracranial–Intracranial Arterial Bypass Based on Indocyanine Green Angiography

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhuoyun Jiang ◽  
Yu Lei ◽  
Liqiong Zhang ◽  
Wei Ni ◽  
Chao Gao ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Bypass Surgery ◽  
Flow Direction ◽  
Blood Perfusion ◽  
Automatic Processing ◽  
Vessel Segmentation ◽  
Commercial Software ◽  
Arterial Bypass ◽  
Before And After

Microvascular imaging based on indocyanine green is an important tool for surgeons who carry out extracranial–intracranial arterial bypass surgery. In terms of blood perfusion, indocyanine green images contain abundant information, which cannot be effectively interpreted by humans or currently available commercial software. In this paper, an automatic processing framework for perfusion assessments based on indocyanine green videos is proposed and consists of three stages, namely, vessel segmentation based on the UNet deep neural network, preoperative and postoperative image registrations based on scale-invariant transform features, and blood flow evaluation based on the Horn–Schunck optical flow method. This automatic processing flow can reveal the blood flow direction and intensity curve of any vessel, as well as the blood perfusion changes before and after an operation. Commercial software embedded in a microscope is used as a reference to evaluate the effectiveness of the algorithm in this study. A total of 120 patients from multiple centers were sampled for the study. For blood vessel segmentation, a Dice coefficient of 0.80 and a Jaccard coefficient of 0.73 were obtained. For image registration, the success rate was 81%. In preoperative and postoperative video processing, the coincidence rates between the automatic processing method and commercial software were 89 and 87%, respectively. The proposed framework not only achieves blood perfusion analysis similar to that of commercial software but also automatically detects and matches blood vessels before and after an operation, thus quantifying the flow direction and enabling surgeons to intuitively evaluate the perfusion changes caused by bypass surgery.

Abstract 136: Prediction of Postoperative Hyperperfusion by Intraoperative Assessment of Indocyanine Green Videoangiography in Moyamoya Disease

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Haruto Uchino ◽  
Masaki Ito ◽  
Ken Kazumata ◽  
Naoki Nakayama ◽  
Satoshi Kuroda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Moyamoya Disease ◽  
Flow Index ◽  
Emission Computed Tomography ◽  
Semiquantitative Analysis ◽  
Bypass Procedure ◽  
Before And After ◽  
Direct Bypass ◽  
Cortical Perfusion

Background: Postoperative hyperperfusion is a potential complication of the direct bypass procedure for moyamoya disease (MMD). However, no reliable modality is available yet for the prediction of postoperative hyperperfusion during surgery for MMD. This study aimed to investigate whether semiquantitative analysis of indocyanine green (ICG) videoangiography could contribute to the prediction of postoperative hyperperfusion in MMD. Methods: This study included 12 hemispheres from 10 patients who underwent surgical revascularization for MMD. Intraoperative ICG videoangiography was performed before and after a direct bypass procedure. The ICG intensity-time curves were semiquantitatively analyzed to evaluate cortical perfusion by calculating the blood flow index (BFI). Using single-photon emission computed tomography (SPECT), postoperative cerebral blood flow measurements were performed thrice: immediately and 2 and 7 days after surgery. Results: BFI significantly increased from 21.3 ± 10.5 to 38.4 ± 20.0 after bypass procedures in all the hemispheres (p < 0.01). The ratio of BFI before and after the bypass procedure was 2.4 ± 2.0, ranging from 0.5 to 8.0. Postoperative hyperperfusion was observed in 9 of the 12 operated hemispheres within 7 days after surgery. Of these, 3 hemispheres developed hyperperfusion immediately after surgery. In the adult cases, the increase in the ratio of BFI after bypass was significantly greater in those who developed hyperperfusion immediately after surgery than in those who did not (6.5 ± 0.5 vs. 1.8 ± 2.1, p < 0.01). In contrast, no significant increase in BFI was observed in the pediatric MMD patients who experienced immediate hyperperfusion. No correlation between the changes in BFI and the occurrence of delayed hyperperfusion was observed. Conclusions: Our results suggest that semiquantitative analysis of BFI by intraoperative ICG videoangiography is useful in evaluating changes in cortical perfusion after bypass procedures for MMD and can predict the occurrence of early-onset hyperperfusion in MMD patients after direct bypass.

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