Intraoperative Intraoperative Indocyanine Green Angiography Research Articles

Surgical considerations and techniques using intraoperative indocyanine green angiography for ethmoidal dural arteriovenous fistula.

This study aims to investigate the efficacy of microsurgery with intraoperative indocyanine green (ICG) angiography as a treatment approach for ethmoidal dural arteriovenous fistula (DAVF). Between January 2010 and July 2021, our institution encountered a total of eight cases of ethmoidal DAVF. In each of these cases, microsurgical treatment was undertaken utilizing a bilateral sub-frontal interhemispheric approach, with the aid of intraoperative ICG angiography. ICG angiography identified bilateral venous drainage with single dominance in four cases (50%) of ethmoidal DAVF, a finding that eluded detection during preoperative transfemoral cerebral angiography (TFCA). The application of microsurgical treatment, in conjunction with intraoperative ICG angiography, resulted in consistently positive clinical outcomes for all patients, as evaluated using the Glasgow Outcome Scale (GOS) at the 6-month postoperative follow-up assessment; six patients showed GOS score of 5, while the remaining two patients attained a GOS score of 4. The use of intraoperative ICG angiography enabled accurate identification of both dominant and non-dominant venous drainage patterns, ensuring complete disconnection of the fistula and reducing the risk of recurrence.

Outcome analysis of free flap reconstruction for head and neck cancer with intraoperative indocyanine green angiography

Intraoperative indocyanine green (ICG) angiography is used in free flap surgery to evaluate the patency of vessel anastomosis. This study evaluated the outcomes of intraoperative ICG angiography in free flap surgery for head and neck cancer. This was a retrospective study of free flap reconstruction for head and neck cancer performed between 2015 and 2021. The outcomes analyzed were the total flap failure rate, re-exploration rate, and flap salvage rate. Differences in outcomes were compared in patients treated using intraoperative ICG angiography and those treated without. Of the 520 free flap surgeries in the 486 enrolled patients, 259 cases underwent intraoperative ICG angiography. In this group, there were 10 (3.9%) cases of total flap failure. In the non-ICG group, there were 22 cases (8.4%). There were 35 (13.5%) cases requiring re-exploration in the ICG group and 40 (15.3%) in the non-ICG group. The difference was not statistically significant. The flap salvage rate was 75.8% (25/33) in the ICG group and 51.4% (18/35) in the non-ICG group, which was a significant difference. We found that free flap surgery with intraoperative ICG angiography significantly decreased total flap failure rate and significantly increased salvage rate but did not significantly affect the re-exploration rate.

Correlation between Colon Perfusion and Postoperative Fecal Output through a Transanal Drainage Tube during Laparoscopic Low Anterior Resection.

Simple SummaryAnastomotic leakage (AL) is a major problem in patients who undergo operations for rectal cancers. Various solutions, such as ICG angiography and transanal drainage tubes (TDT), have been proposed to prevent AL. Although the microbiota has recently been recognized to play a role in the pathogenesis of AL, mainly from the results of experimental animal models, it remains unclear whether this mechanism can occur in humans. In this study, we investigated the relationship between intestinal perfusion and fecal volume through TDT in laparoscopic low anterior resection, and found that the need of a proximal shift of the transection site due to insufficient intestinal perfusion was significantly associated with high fecal volume, which might reflect the correlation between intestinal perfusion and postoperative diarrhea. In addition, we found that the intensity of ICG fluorescence at the transection site was significantly associated with fecal volume through TDT. To the best of our knowledge, this is the first clinical study to examine the relationship between intestinal perfusion and fecal volume through TDT. In order to prevent anastomotic leakage (AL) following rectal surgery, various solutions—such as intraoperative indocyanine green (ICG) angiography and transanal drainage tubes (TDT)—have been proposed. This study investigated the relationship between intestinal perfusion and fecal volume through TDT in laparoscopic low anterior resection (LAR). A total of 59 rectal cancer patients who underwent laparoscopic LAR with both intraoperative ICG angiography and postoperative TDT placement were retrospectively analyzed. The relationship between intestinal perfusion and fecal volume through TDT was examined. Based on the ICG fluorescence, the transection site was shifted more proximally in 20 cases (33.9%). Symptomatic AL occurred in seven patients (11.8%). The AL rate of the patients whose daily fecal volume exceeded 100 mL/day in 2 or more days was significantly higher than that of those whose daily fecal volume exceeded it in 0 or 1 day (44.4% vs. 6.0%; p < 0.01). Univariate and multivariate analyses showed that the need for a proximal shift of the transection site was significantly associated with a high fecal volume. The quantitative analysis of ICG fluorescence indicated that Fmax (the fluorescence difference between the baseline and maximum) was significantly associated with fecal volume through TDT.

Mesenteric Vascular Evaluation with Pre-operative Multidetector Computed Tomographic Angiography and Intraoperative Indocyanine Green Angiography to Reduce Anastomotic Leaks after Minimally Invasive Surgery for Colorectal Cancer

Background:The aim of this prospective study was to determine the effect of mesenteric vascular evaluation using pre-operative multidetector computed tomography angiography (MDCTA) and intraoperative indocyanine green (ICG) angiography on reducing the anastomotic leak rate of colorectal cancer patients undergoing minimally invasive resection.Methods:Twenty-seven consecutive patients with colorectal cancer were studied, 18 males and 9 females, average age 69.1 ± 3.9 years. All patients underwent pre-operative mesenteric vascular evaluation using MDCTA with three-dimensional (3D) reconstruction and intraoperative evaluation of perfusion using ICG angiography. Twelve patients underwent laparoscopic resection (Olympus Visera Elite II OTV-S200) and 15 patients underwent robotic resection (DaVinci Si). Colorectal resection lines and anastomoses were guided by intraoperative ICG perfusion. Postoperative anastomotic leaks were assessed.Results:Pre-operative MDCTA 3D reconstructions defined the left colic and sigmoid artery anatomy and guided operative planning. The intraoperative ICG angiography resulted in a change of the planned lines of resection in seven patients (26%). The rate of postoperative anastomotic leaks in this study was 0% (0/27), compared to a leak rate of 6.8% at our institution in the preceding two years.Conclusion:Pre-operative evaluation of mesenteric vascular anatomy using MDCTA with 3D reconstruction and intraoperative evaluation of perfusion using ICG angiography were found to be technically feasible and safe. An appropriately designed study should be undertaken to prove whether it was truly effective at reducing the postoperative anastomotic leak rate in colorectal cancer patients undergoing minimally invasive resection at our institution.

Indocyanine Green Angiography for Quality Assessment of the Kidney During Transplantation: An Outcome Predictor Prospective Study

Microvascular damage is the main cause of delayed graft function (DGF) after kidney transplant. Assessing its extent may be helpful in predicting DGF to achieve better postoperative management, especially in terms of an immunosuppressive regimen. Our aim was to explore the capability of intraoperative indocyanine green (ICG) angiography to examine the microvasculature of the kidney. We conducted a prospective cohort study on 37 kidney transplant recipients in a high-volume kidney transplant center. During surgery, after graft implant, an ICG angiography was performed through a high-definition Storz camera system (Karl Storz GmbH, Tuttlingen, Germany) with successive quantitative assessment of fluorescence using Icy bioimage analysis. All transplanted kidneys that showed immediate recovery of their function had a fluorescent intensity ≥49.953 with a mean of 96.930 ± 21. The fluorescence intensity for kidneys that showed a delayed recovery of their function never exceeded 55.648, and the mean was37.718 ± 13. The difference between the 2 groups was statistically significant with a P value < .001. The only kidney that never recovered showed a fluorescence intensity consistently <25.220, the lowest detected. This study demonstrates that intraoperative ICG angiography may be used to assess the microvasculature of the graft.A statistically significant difference in terms of fluorescent intensity can be highlighted between kidneys that immediately recover their function and those with delayed recovery.Further larger studies are needed to confirm the capability of the technique to predict DGF to optimize the transplanted patients' management.

Research on Intra-Operative Indocyanine Green Angiography of the Parathyroid for Predicting Postoperative Hypoparathyroidism: A Noninferior Randomized Controlled Trial

A noninferiority randomized controlled trial was undertaken to clarify whether the postoperative measurements of serum calcium and parathyroid hormone and oral supplementation of calcium and calcitriol could be omitted if patients had at least one well-perfused parathyroid gland evaluated by intra-operative indocyanine green (ICG) angiography. Patients with at least one parathyroid gland well-perfused by ICG angiography (ICG score >2) were randomized to the control group or test group. For the control group, oral calcium and calcitriol were systematically supplemented. For the test group, no oral calcium or calcitriol was supplemented to the patients. Levels of serum calcium and parathyroid hormone of patients on the first and 30th postoperative day were compared between the two groups. Among all 68 selected patients, 56 patients had at least one well-perfused parathyroid gland evaluated by intra-operative ICG angiography. The 56 patients were randomized to the control group or test group. There were no statistically significant differences in the levels of serum calcium and parathyroid hormone between test group and control group on the first or 30th postoperative day. The postoperative measurements of serum calcium and parathyroid hormone and oral supplementation of calcium and calcitriol were evaluated as redundant, if patients had at least one well-perfused parathyroid gland evaluated by intra-operative ICG angiography. ICG = indocyanine green; NIR = near infrared; POD = postoperative day; PTH = parathyroid hormone; SBR = signal background ratio.

Multivariable analysis for flap-related complications in autologous breast reconstruction and economic analysis of intraoperative indocyanine green angiography

To investigate the influencing factors of flap-related complications and the economic benefits of intraoperative indocyanine green (ICG) angiography in the patients undergoing autologous breast reconstruction. Between July 2013 and June 2018, the clinical data of 150 patients (152 breasts) who met the selection criteria after autologous breast reconstruction were analyzed retrospectively. Ten factors including age, body mass index, preoperative neoadjuvant chemotherapy (NC), chest radiation history, diabetes, abdominal operation history, chest wall reconstruction, reconstruction timing, flap type, intraoperative ICG angiography were analyzed by univariate analysis. Significant variables found in univariate analysis were used to perform backward multivariate logistic regression of flap related complications and local necrosis. According to the above multi factor analysis results, the patients were divided into 4 groups: ICG+NC group (group A), ICG+non-NC group (group B), non-ICG+NC group (group C), non-ICG+non-NC group (group D). The average extra costs of surgical treatment (including ICG imaging cost+cost of handling flap related complications) of each group was calculated. All the 152 flaps survived. There were 33 flap-related complications, including 22 regional necrosis, 9 regional infection, 5 hematoma, 5 simple fat liquefaction, and 2 anasto-motic thrombosis. Univariate analysis showed that preoperative NC, flap type, and intraoperative ICG angiography had significant influence on the incidence of flap-related complications ( P<0.05). Multivariate analysis showed that preoperative NC and non-ICG angiography were the risk factors of flap-related complications ( P<0.05), and also the risk factors of regional flap necrosis ( P<0.05). For patients who had NC, intraoperative ICG angiography could greatly save the average extra costs. The average extra costs in group A was 1 378 yuan less than that in group C. For the patients without NC, intraoperative ICG angiography would increase the average extra costs, which was 747 yuan in group B more than that in group D. In autologous breast reconstruction, ICG angiography can reduce the incidence of flap-related complications, especially the incidence of regional flap necrosis, while NC is the opposite. For patients without NC, ICG angiography is not cost-effective but still can be used if conditions permit. However, for those with NC, ICG angiography is cost-effective and recommended.

Outcomes using indocyanine green angiography with perforator-sparing component separation technique for abdominal wall reconstruction.

Usage of intraoperative indocyanine green (ICG) to assess skin flaps prior to abdominal wall closure has been shown to decrease postoperative wound-related complications. Primary outcome assessed is the utility of ICG in intraoperative decision making. Secondary outcomes analyzed are the incidence of surgical site occurrence (SSO) and hernia recurrence rates. A retrospective study using the MedStar Georgetown University Hospital database was conducted, incorporating all consecutive patients undergoing complex incisional hernia repair from 2008 to 2018. 146 patients underwent perforator-sparing component separation (PSCST), 88 underwent flap assessment using intraoperative ICG angiography; they were then analyzed based on patient comorbidities, Ventral Hernia Working Group grade, operative factors, and complications. A total of 146 patients were analyzed with no statistical difference in patient characteristics between the SPY and no SPY group except in BMI (30.2 vs. 33.2kg/m2, p = 0.036). The no SPY group also had higher numbers of patients undergoing concurrent panniculectomy (12 vs. 1, p < 0.001), and extensive lysis of adhesions (30 vs. 31, p = 0.048). Of the 88 patients undergoing intraoperative SPY, 37 (42%) patients had a change of intraoperative management as defined by further subcutaneous skin flap debridement. Despite this change, there was no statistical difference in incidence of SSO between SPY and no SPY (24.3% vs. 11.8%, p = 0.12), and no difference in hernia recurrence rates 5.6% (n = 5) versus 13.7% (n = 8), p = 0.09. Intraoperative ICG assessment of subcutaneous skin flaps with a perforator-sparing component separation does not result in a decrease in surgical site occurrences.

Improved Arterial Preservation Achieved by Combined Use of Indocyanine Green Angiography and Doppler Detector During Microsurgical Subinguinal Varicocelectomy

Objectives: The microsurgical approach is considered the most reliable procedure in varicocelectomy. However, as there are difficulties in identifying the spermatic artery at the peripheral level, we had introduced intraoperative indocyanine green angiography (ICGA) for identification of arteries. In this study, we further investigated the usefulness of intraoperative ICGA in combination with an ordinary Doppler detector in microsurgical subinguinal varicocelectomy. Methods: A total of 140 men who underwent microsurgical subinguinal varicocelectomy at Gunma University Hospital were included. An operating microscope equipped with a near-infrared charge-coupled device was used for intraoperative ICGA. After exposing the vessels, arteries were identified using endoscopic vision only or with assistance of Doppler detector or ICGA, or of both. The number of preserved arteries was compared among the groups. Results: ICGA clearly visualized the internal spermatic arteries in all cases, allowing the surgeon to perform real-time identification and isolation of the spermatic artery intraoperatively. The use of ICGA or Doppler detector significantly increased the number of preserved arteries compared to the microscope-only operation from 1.11 to 1.75 (p < 0.05) and 1.57 (p < 0.05), respectively. The additional use of ICGA with Doppler detector further increased the number of preserved arteries to 2.41 (p < 0.05). Conclusions: Intraoperative ICGA facilitated safe and quick microsurgical subinguinal varicocelectomy by enabling visualization of thin spermatic cord blood vessels. Improved preservation of thin arteries, which is essential for patients with infertility, can be achieved with the combined use of ICGA and ordinary Doppler detector.

Flap warming improves intraoperative indocyanine green angiography (ICGA) assessment of perfusion. An experimental study

Indocyanine green angiography (ICGA) is slowly replacing conventional methods of evaluating perfusion during flap surgery. Microcirculatory changes during flap elevation create a marked state of hypoperfusion intraoperatively leading to ICGA underestimation of tissue viability and consequent resection of viable tissue. We propose a novel method of flap warming to induce maximum vasodilation before performing ICGA to increase accuracy in assessing perfusion. Submental flaps harvested on a single perforator were created in 8 pigs. ICG angiography was performed in the intraoperative phase (ICGA-C), after inducing maximum vasodilatation by warming the flap at 42 °C (ICGA-W) and at 24H postoperative (ICGA-24). By setting a fluorescence threshold of 33% as indicative of necrosis, the flap surface deemed viable by ICGA was measured for ICGAC, ICGAW and ICGA24. The results were then compared to the actual flap survival observed clinically at 7 days. The mean of ICG-C predicted flap survival (FS-C = 49.17%) is 12.97% lower than the mean of actual flap survival on postoperative day 7 (FS=62.14%). The mean difference between ICG-W and ICG-24 predicted flap survival (FS-W and FS-24) and actual flap survival in the postoperative day 7 (FS) is lower, 3.13% and 2.15%, respectively. Average perfusion recovery over 24 h was 10.83% (FS-24-FS-C). Conventional intraoperative ICGA underestimated perfusion in all cases. Warming the flap intraoperatively and achieving maximum vasodilation mitigates the effects of vasoconstriction and mimics the microcirculatory environment encountered at 24 h. Performing angiography after induced vasodilation improves ICGA assessment of flap perfusion.

Use of video microsurgery platform in microsurgical subinguinal varicocelectomy with indocyanine green angiography

AimThe aim of the present study was to evaluate the feasibility of the use of the video microsurgery platform and fluorescence imaging exoscope system for microsurgical subinguinal varicocoelectomy (MSV) with intraoperative indocyanine green angiography (ICGA).Patients and MethodsTwo patients with three varicoceles had MSV and intraoperative ICGA performed in August 2018. A video telescopic operating microscope (VITOM) 3‐D system and a VITOM II ICG system were connected to a modular FULL HD IMAGE1 S camera platform. Both telescopes were mounted for convenient positioning and switch between the telescopes.ResultsThe VITOM 3‐D system provided excellent, high‐definition image quality and anatomical details necessary for the procedure of MSV. The system offered a more ergonomic working environment for the operating surgeons. The addition of VITOM II ICG system allowed intraoperative ICGA for better identification of the testicular artery. Testicular arteries were clearly identified and preserved. The setup with holding arms and a camera platform facilitated quick switch between the video systems.ConclusionsThe procedure of MSV with intraoperative ICGA can be performed efficiently with the utilization of the video microsurgery platform.

MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-02 EFFICACY OF INDOCYANINE GREEN FLUORESCENCE ANGIOGRAPHY FOR ARTERIAL SPARING DURING MICROSURGICAL SUBINGUINAL VARICOCELECTOMY Yasuhiro Shibata, Sota Kurihara, Seiji Arai, Takeshi Miyao, Yoshiyuki Miyazawa, Yoshitaka Sekine, Hidekazu Koike, Kazuto Ito, Tetsuya Nakamura, and Kazuhiro Suzuki Yasuhiro ShibataYasuhiro Shibata More articles by this author , Sota KuriharaSota Kurihara More articles by this author , Seiji AraiSeiji Arai More articles by this author , Takeshi MiyaoTakeshi Miyao More articles by this author , Yoshiyuki MiyazawaYoshiyuki Miyazawa More articles by this author , Yoshitaka SekineYoshitaka Sekine More articles by this author , Hidekazu KoikeHidekazu Koike More articles by this author , Kazuto ItoKazuto Ito More articles by this author , Tetsuya NakamuraTetsuya Nakamura More articles by this author , and Kazuhiro SuzukiKazuhiro Suzuki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2800AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicoceles are present in 20 to 30% of men with infertility; moreover, up to 10% of men with varicoceles experience scrotal pain. Varicocelectomy improves testicular function and may prevent the accelerated decline in sperm parameters and testosterone levels observed in men with varicoceles. Many studies have indicated that microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles with regard to spontaneous pregnancy outcomes and complication rates; however, the difficulty in identifying testicular arteries that should be spared is a limitation of this technique. We previously reported the usefulness of intraoperative indocyanine green angiography (ICGA) to detect the thin arteries. In the present study, we assessed the feasibility of ICGA during microsurgical subinguinal varicocelectomy in comparison with standard procedures. METHODS Microsurgical subinguinal varicocelectomy using ICGA was performed in 48 patients with infertility or chronic pain associated with varicoceles. After exposure of the spermatic cord blood vessels, ICG was injected intravenously to identify and isolate the testicular artery. Intraoperative Doppler blood flow meter was also performed in 29 cases to compare both procedures for detection of the artery. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. Seventy-eight cases without ICGA use were included as the control group, to determine the efficacy of the ICGA procedure. RESULTS The testicular artery was clearly identified by ICGA. The average operation time significantly decreased from 81.8 to 66.2 minutes with the use of ICGA. The number of preserved arteries was significantly increased by ICGA from 1.16 to 1.77. In 15 ICGA cases, very thin arteries that were undetectable with normal light view or Doppler study could be preserved. CONCLUSIONS Microsurgical subinguinal varicocelectomy using intraoperative ICGA enabled a faster procedure and secure preservation of testicular arteries. We believe that this is a significant surgical procedure for the treatment of varicoceles, especially for infertility patients in whom preservation of maximal blood supply is desired. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1202-e1203 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yasuhiro Shibata More articles by this author Sota Kurihara More articles by this author Seiji Arai More articles by this author Takeshi Miyao More articles by this author Yoshiyuki Miyazawa More articles by this author Yoshitaka Sekine More articles by this author Hidekazu Koike More articles by this author Kazuto Ito More articles by this author Tetsuya Nakamura More articles by this author Kazuhiro Suzuki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of Indocyanine Green Angiography on Microsurgical Subinguinal Varicocelectomy

ABSTRACTObjectives: Microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles related to male infertility and scrotal pain. However, the difficulty in identifying testicular arteries, which should be spared, is a limitation of this technique. To visualize and identify the testicular arteries in spermatic cord during the operation, we examined the efficacy of intraoperative indocyanine green angiography (ICGA), which is regularly used in microsurgical neurosurgery. Methods: After the exposure of the spermatic cord blood vessels, ICG was injected intravenously under a surgical microscope for observing infrared fluorescence in patients to identify and isolate the testicular artery. Results: The testicular artery was clearly identified by ICGA and was able to separate under ICGA view. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. The preserved arteries were confirmed by repeated ICGA at the end of microsurgical operation. The number of arteries identified by ICGA was greater than the number detected by preoperative computed tomography angiogram. Conclusions: Microsurgical subinguinal varicocelectomy using intraoperative ICGA facilitated safe and quick surgery by enabling the visualization of the spermatic cord blood vessels. This is the first report to indicate the usefulness of vessel visualization by ICGA during microsurgical subinguinal varicocelectomy.

Combined use of intraoperative indocyanine green and dynamic angiography in rotational vertebral artery occlusion

Rotational vertebral artery occlusion, also known as bow hunter’s syndrome, is a well-documented surgically amenable cause of vertebrobasilar insufficiency. Traditionally, patients have been imaged using dynamic rotational angiography. The authors sought to determine whether intraoperative indocyanine green (ICG) angiography could reliably assess the adequacy of surgical decompression of the vertebral artery (VA). The authors report two patients who presented with multiple transient episodes of syncope provoked by turning their head to the right. Rotational dynamic angiography revealed a dominant VA that became occluded with head rotation to the right side. The patients underwent successful surgical decompression of the VA via an anterior cervical approach. Intraoperative ICG angiography demonstrated patency of the VA with head rotation. This was further confirmed by intraoperative dynamic catheter angiography. To our knowledge, we present the first two cases of the use of ICG combined with intraoperative dynamic rotational angiography to document the adequacy of surgical decompression of the VA in a patient with rotational vertebral artery occlusion. Intraoperative ICG angiography is a useful adjunct and may potentially supplant the need for intraoperative catheter angiography.

精索静脈瘤に対する術中インドシアニングリーン蛍光血管造影下顕微鏡下低位結紮術の有用性：予備的検討

Microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles. However, the difficulty in identifying testicular arteries that should be spared is a limitation of this technique. We assessed the efficacy of intraoperative indocyanine green angiography (ICGA) during microsurgical subinguinal varicocelectomy in three pilot cases. We performed microsurgical subinguinal varicocelectomy using a surgical microscope for observing infrared fluorescence in patients with infertility or chronic pain associated with varicoceles. After the exposure of the spermatic cord blood vessels, ICG was injected intravenously to identify and isolate the testicular artery. Thereafter, the varicose veins were repeatedly ligated, while preserving a few lymphatic vessels and the spermatic duct. The testicular artery could be clearly identified by ICGA and were able to separate under ICGA. The preserved arteries were confirmed by ICGA at the end of microsurgical operation. Though, all the internal spermatic veins could be safely ligated, while sparing the testicular arteries and lymphatic vessels. Microsurgical subinguinal varicocelectomy using intraoperative ICGA facilitated safe and quick surgery by enabling the visualization of the spermatic cord blood vessels. This is the first report to indicate the usefulness of vessel visualization by ICGA during microsurgical subinguinal varicocelectomy.

Intraoperative indocyanine green angiography during microvascular decompression surgery: report of 30 cases.

The purpose of this study was to evaluate the use of intraoperative indocyanine green (ICG) angiography during microvascular decompression (MVD) surgery. The surgical outcomes of 19 patients with hemifacial spasm, nine patients with trigeminal neuralgia, and two patients with glossopharyngeal neuralgia who were treated with MVD surgery, using the posterior approach and routine craniotomy, via procedures in which ICG angiography was used were analyzed retrospectively. ICG angiography clearly displayed the nerves and blood vessels. Among the 30 patients, 25 were cured, four showed improvements, and one had a worsened outcome. There were no significant complications. Outcome was not associated with age, gender, or diagnosis. Intraoperative ICG angiography used during MVD surgery provided a clear display of the nerves and arteries. All but one patient was cured or had improvement. The findings suggest that intraoperative ICG angiography may be an effective supplemental technique for use during MVD surgery.

Is It Safe to Sacrifice the Superior Hypophyseal Artery in Aneurysm Clipping? A Report of Two Cases

Clipping of paraclinoid internal carotid artery aneurysms related to the superior hypophyseal artery (SHA) carries risk of occlusion of this artery when originating distal to the neck of the aneurysm. Sometimes it is inevitable to sacrifice the artery to achieve total aneurysm occlusion. Otherwise a residual aneurysm would remain, which may lead to aneurysm regrowth and subsequent rupture. However, consequences of SHA sacrifice are rarely reported in the literature. In the two presented cases, the SHA was found originating distal to the neck and within the wall of the aneurysm, making the optimal clipping of the aneurysm at the neck unfeasible without trapping of the SHA. Intraoperative indocyanine green (ICG) angiography revealed a retrograde blood flow in the SHA distal to the clip in both patients, indicating some collateral circulation. No endocrinologic deficits were encountered after surgery. The vision was not affected in one patient. In the other patient, bilateral visual field defects occurred, which improved partially in the follow-up 2 months after surgery. The consequences of SHA occlusion are difficult to predict. A large variety of anatomical variations of the vascular anatomy exists. Intraoperative ICG angiography may help to estimate collateral blood flow but is not able to predict visual decline. Although final conclusions cannot be drawn from two patients, it seems that in case of multiplicity of superior hypophyseal complex, sacrifice of one even larger branch is safe. However, visual sequelae have to be taken into consideration when a single SHA has to be sacrificed for total aneurysm clipping.

Preliminary evaluation of the role of surgical microscope-integrated intraoperative FLOW 800 colored indocyanine fluorescence angiography in arteriovenous malformation surgery

To discuss the role of FLOW 800 innovative software for analytical color visualization and objective evaluation of fluorescence videos obtained by microscope-integrated intraoperative indocyanine green (ICG) fluorescence angiography in arteriovenous malformations (AVM) surgery. Microscope-integrated intraoperative FLOW 800 was used and evaluated in three consecutive AVM surgeries over a period of two months. The role of FLOW 800 to distinguish feeding arteries from arterialized veins and other arteries was evaluated. Its advantages and limitations over conventional intraoperative ICG angiography were evaluated. This software was found to be useful in identifying arterial feeders, arterialized veins and other arteries in all the three patients and it gives additional information on the status of AVM before and after clipping suspected feeders which is sometimes difficult to interpret on conventional ICG angiography. Flow 800 is a reliable and useful addition to microscope-integrated color ICG video angiography. Although its role is limited in deep-seated AVMs, if properly dissected and exposed it can give useful information which can be easily interpretable and reproducible.

Intraoperative indocyanine green angiography as a substitute for conventional angiography in the surgical management of spinal dural arteriovenous fistulae

IntroductionSpinal dural arteriovenous fistula (dAVF) is the most common vascular malformation of the spinal cord. We performed a prospective observational study of patients with spinal dAVF who were treated by...

Application of indocyanine green angiography in bypass surgery for moyamoya disease

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.