Role of Indocyanine Green Videoangiography in Identification of Donor and Recipient Arteries in Cerebral Bypass Surgery

  • Giuseppe EspositoEmail author
  • Sandra Dias
  • Jan-Karl Burkhardt
  • Oliver Bozinov
  • Luca Regli
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)


The identification and preparation of a very good quality donor artery is a crucial step in every superficial temporal artery to middle cerebral artery (STA-MCA) bypass.

For flow-preservation bypass performed for trapping of complex MCA aneurysms, the key element is the correct target of the recipient artery. When a cortical recipient artery (M4 segment of the MCA) is selected, this vessel must be a terminal branch of the artery whose sacrifice is necessary for definitive aneurysmal treatment.

In this chapter we report on two techniques for (1) intraoperative mapping and preparation of good quality STA branch as the donor artery for STA-MCA bypass (mostly in the case the frontal branch of the STA needs to be used) and (2) selective identification of the correct superficial (M4 cortical) “recipient” artery in flow-preservation STA-MCA bypass performed for managing complex MCA aneurysms.

Both techniques are based on the use of microscope-integrated indocyanine green videoangiography (ICG-VA), an intraoperative tool allowing observation and real-time assessment of blood flow in large and small vessels, with distinct evaluation of arterial, capillary, and venous phases.

The two techniques contribute, respectively, to (1) reduce the risk of erroneous identification or injury of the donor artery in STA-MCA bypass procedures and (2) eliminate the risk of erroneous revascularization of a non-involved arterial territory in flow-preservation bypass surgery for managing complex MCA aneurysms.


Cerebral bypass Donor artery Extra-intracranial bypass Flow-preservation bypass Indocyanine green videoangiography—ICGVA Neurosurgery Recipient artery Selective revascularization 



Digital subtraction angiography


Extracranial to intracranial


Indocyanine green videoangiography


Middle cerebral artery


Superficial temporal artery


Superficial temporal artery to middle cerebral artery



The authors report no conflicts.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Giuseppe Esposito
    • 1
    Email author
  • Sandra Dias
    • 1
  • Jan-Karl Burkhardt
    • 1
  • Oliver Bozinov
    • 1
  • Luca Regli
    • 1
  1. 1.Department of NeurosurgeryUniversity Hospital Zurich, University of ZurichZurichSwitzerland

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