Abstract
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.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- DSA:
-
Digital subtraction angiography
- EC-IC:
-
Extracranial to intracranial
- ICGVA:
-
Indocyanine green videoangiography
- MCA:
-
Middle cerebral artery
- STA:
-
Superficial temporal artery
- STA-MCA:
-
Superficial temporal artery to middle cerebral artery
References
Esposito G, Burkhardt JK, Bozinov O, Regli L. Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery. Acta Neurochir. 2016;158:565–70.
Esposito G, Amin-Hanjani S, Regli L. Role of and indications for bypass surgery after carotid occlusion surgery study (COSS)? Stroke. 2016;47:282–90.
Esposito G, Durand A, Van Doormaal T, Regli L. Selective-targeted extra-intracranial bypass surgery in complex middle cerebral artery aneurysms: correctly identifying the recipient artery using indocyanine green videoangiography. Neurosurgery. 2012;71:ons274–84; discussion ons284–285.
Esposito G, Fierstra J, Regli L. Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms. Acta Neurochir. 2016;158:1523–31.
Esposito G, Fierstra J, Regli L. Partial trapping strategies for managing complex intracranial aneurysms. Acta Neurochir Suppl. 2016;123:73–5.
Esposito G, Regli L. Selective targeted cerebral revascularization via microscope integrated indocyanine green videoangiography technology. Acta Neurochir Suppl. 2014;119:59–64.
Esposito G, Regli L. Surgical decision-making for managing complex intracranial aneurysms. Acta Neurochir Suppl. 2014;119:3–11.
Kronenburg A, Esposito G, Fierstra J, Braun KP, Regli L. Combined bypass technique for contemporary revascularization of unilateral MCA and bilateral frontal territories in moyamoya vasculopathy. Acta Neurochir Suppl. 2014;119:65–70.
Burkhardt JK, Esposito G, Fierstra J, Bozinov O, Regli L. Emergency non-occlusive high capacity bypass surgery for ruptured giant internal carotid artery aneurysms. Acta Neurochir Suppl. 2016;123:77–81.
Jafar JJ, Russell SM, Woo HH. Treatment of giant intracranial aneurysms with saphenous vein extracranial-to-intracranial bypass grafting: indications, operative technique, and results in 29 patients. Neurosurgery. 2002;51:138–44; discussion 144–146.
Sekhar LN, Natarajan SK, Ellenbogen RG, Ghodke B. Cerebral revascularization for ischemia, aneurysms, and cranial base tumors. Neurosurgery. 2008;62:1373–408; discussion 1408–1410.
Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V. Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery. 2003;52:132–9; discussion 139.
Scerrati A, Della Pepa GM, Conforti G, Sabatino G, Puca A, Albanese A, Maira G, Marchese E, Esposito G. Indocyanine green video-angiography in neurosurgery: a glance beyond vascular applications. Clin Neurol Neurosurg. 2014;124:106–13.
Pinar YA, Govsa F. Anatomy of the superficial temporal artery and its branches: its importance for surgery. Surg Radiol Anat. 2006;28:248–53.
Disclosure
The authors report no conflicts.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this paper
Cite this paper
Esposito, G., Dias, S., Burkhardt, JK., Bozinov, O., Regli, L. (2018). Role of Indocyanine Green Videoangiography in Identification of Donor and Recipient Arteries in Cerebral Bypass Surgery. In: Esposito, G., Regli, L., Kaku, Y., Tsukahara, T. (eds) Trends in the Management of Cerebrovascular Diseases. Acta Neurochirurgica Supplement, vol 129. Springer, Cham. https://doi.org/10.1007/978-3-319-73739-3_12
Download citation
DOI: https://doi.org/10.1007/978-3-319-73739-3_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-73738-6
Online ISBN: 978-3-319-73739-3
eBook Packages: MedicineMedicine (R0)