“Squeeze Maneuver” Assisted by Indocyanine Green Videoangiography: Simple Technique to “Resuscitate” Partially Occluded Bridging Veins During Microneurosurgical Operations

Abstract

The preservation of normal peri/intralesional bridging veins is extremely important in every microneurosurgical operation. The purpose of our study was to describe the "squeeze maneuver" assisted by indocyanine green videoangiography (ICGV), a simple technique to "resuscitate" partially occluded bridging veins during microneurosurgical operations. When a bridging vein is inadvertently stretched up to its collapse during microneurosurgical procedures, a precise identification of the partially occluded zone is carried out under high magnification (10-15×), as well as with the aid of the ICGV. If a continuous irrigation with isotonic saline solution does not allow one to reestablish the venous flow, the "squeeze maneuver" is carried out. This consists of squeezing and sliding with the bipolar forceps the occluded vessel along the normal venous flow direction. This procedure is repeated several times, while a continuous saline irrigation is applied. The ICGV is performed to confirm an adequate patency of the vein. This maneuver permits to restore the normal diameter of the vein and blood flow inside it. The "squeeze maneuver" assisted by ICGV represents a safe, clean, fast, and even cheap method for restoring the flow of partially occluded bridging veins during microneurosurgical operations.