Application of indocyanine green angiography in bypass surgery for moyamoya disease

Abstract

To explore the role of intraoperative indocyanine green angiography (ICGA) in the bypass surgery for moyamoya disease (MMD). Thirty-seven MMD patients were surgically treated and prospectively recruited. Intraoperative ICGA was performed with a surgical microscope with integrated ICGA technology. ICGA was performed 60 times in 37 patients. In each patient, upon the completion of anastomosis, a near-infrared light emitted by laser diodes was used to illuminate the operating field and the intravascular fluorescence recorded by an optical filter-equipped video camera. Assessment of vascular patency and occlusion were also investigated. The findings of ICGA were compared with those of postoperative DSA (digital subtraction angiography). In all cases, excellent visualization of cerebral arteries was achieved. The information provided by intraoperative ICGA significantly changed the surgical procedures. ICGA was used to identify 2 nonfunctioning STA-MCA (superficial temporal artery-middle cerebral artery) bypasses and both could be revised successfully. In all cases the final findings of ICGA could be positively validated by DSA during the postoperative course. As one kind of intraoperative angiography, ICGA provides a reliable and rapid intraoperative assessment of bypass patency. ICGA has a high spatial resolution and it facilitates the identification of stenoses and obstruction at the anastomotic site or vascular obstructions. It is a helpful tool for the intraoperative evaluation of bypass patency.