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Selective-targeted Extra-intracranial Bypass Surgery in Complex Middle Cerebral Artery Aneurysms: Correctly Identifying the Recipient Artery Using Indocyanine Green Video-angiography.
MedLine Citation:
PMID:  22902337     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Treatment of complex middle cerebral artery (MCA) aneurysms often requires vessel sacrifice or prolonged temporary occlusion with extra- to intracranial (EC-IC) bypass to preserve perfusion. A crucial surgical step is the identification of the bypass recipient artery matching the distal territory of the involved vessel. OBJECTIVE:: To report about the feasibility and efficiency of an Indocyanine green video-angiography (ICG-VA) assisted technique for identification of cortical recipient vessels in order to perform selective-targeted EC-IC bypass. METHODS:: The proposed technique is based on the analysis of differences in the timing of filling of M4 vessels seen on serial ICG-VAs. A delayed fluorescence can be visualized either primarily on a baseline ICG-VA or secondarily on an ICG-VA performed during temporary occlusion of the involved MCA branch. M4 branches presenting delayed fluorescence represent suitable bypass recipient arteries. We report seven consecutive patients treated for complex MCA aneurysms with selective-targeted EC-IC bypass. RESULTS:: Application of the proposed technique permitted the correct identification of recipient arteries (cortical branches of the involved MCA segment) in all patients. The cortex distal to the occlusion filled concomitantly on ICG-VA at the end of surgery. All patients underwent successful treatment of the aneurysm including a cortical bypass. There were no ischemic complications and a favorable clinical outcome was achieved in all patients (mRS at follow-up ≤ mRS preoperative). CONCLUSION:: The proposed ICG-VA based technique enables reliable and accurate identification of the cortical recipient artery and eliminates the risk of erroneous revascularization of non-involved territories.
Authors:
Giuseppe Esposito; Anne Durand; Tristan Van Doormaal; Luca Regli
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-16
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurosurgery, Division of Neuroscience, Rudolf Magnus Institute, University Medical Center Utrecht, the Netherlands 2Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy 3Service de Neurochirurgie D, Hopital neurologique Pierre Wertheimer GHE.
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