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Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease

  • Original Article - Vascular
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Abstract

Background

The middle meningeal artery (MMA) is well known to function as an important collateral channel to the territory of the anterior cerebral artery in moyamoya disease. This study was aimed to evaluate whether indocyanine green (ICG) videoangiography could visualize the anterior branch of the MMA before craniotomy during surgical revascularization for moyamoya disease.

Methods

This study included 19 patients who developed TIA, ischemic stroke or hemorrhagic stroke due to moyamoya disease. Plain CT scan and three-dimensional time-of-flight MR angiography were performed in all patients before surgery. All of them underwent superficial temporal artery to middle temporal artery anastomosis and indirect bypass on 27 sides in total.

Results

ICG videoangiography could clearly visualize the anterior branch of the MMA in 10 (37%) of 27 sides. The patients with a “visible” MMA are significantly younger than those without. Radiological analysis revealed that ICG videoangiography could visualize it through the cranium when the diameter of the MMA is >1.3 mm and the sphenoid bone thickness over the MMA is <3.0 mm. The MMA could be preserved during craniotomy in all “visible” MMAs, but not in 4 (23.5%) of 17 “invisible” MMAs. The results strongly suggest that ICG videoangiography can visualize the anterior branch of the MMA before craniotomy in about one-third of patients with a large-diameter MMA (>1.3 mm) and thin sphenoid bone (<3.0 mm).

Conclusion

ICG videoangiography is a safe and valuable technique to preserve the anterior branch of the MMA during craniotomy for moyamoya disease.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan

    Nozomu Tanabe, Shusuke Yamamoto, Daina Kashiwazaki, Naoki Akioka, Naoya Kuwayama & Satoshi Kuroda

  2. Department of Radiology, Graduate School of Medicine and Pharmaceutical Science, University of Toyama, Toyama, Japan

    Kyo Noguchi

Authors
  1. Nozomu Tanabe
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  2. Shusuke Yamamoto
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  3. Daina Kashiwazaki
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  4. Naoki Akioka
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  5. Naoya Kuwayama
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  6. Kyo Noguchi
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  7. Satoshi Kuroda
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Corresponding author

Correspondence to Satoshi Kuroda.

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Disclosure

The Research Committee on Moyamoya Disease sponsored by the Ministry of Health, Labor, and Welfare of Japan provided financial support in the form of annual funding. The sponsor had no role in the design or conduct of this research. Satoshi Kuroda received the funding.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Comments

This manuscript examines the use of indocyanine green (ICG) to visualize the middle meningeal artery (MMA) prior to craniotomy for surgical revascularization in moyamoya disease. The authors present a novel surgical technique to help preserve the anterior branch of the MMA, so this is an innovative and original work that is of significant interest.

Fady T. Charbel, Sophia F. Shakur

Chicago, IL, USA

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Tanabe, N., Yamamoto, S., Kashiwazaki, D. et al. Indocyanine green visualization of middle meningeal artery before craniotomy during surgical revascularization for moyamoya disease. Acta Neurochir 159, 567–575 (2017). https://doi.org/10.1007/s00701-016-3060-5

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  • DOI: https://doi.org/10.1007/s00701-016-3060-5

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