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Fluorescein videoangiography during extracranial-to-intracranial bypass surgery: preliminary results

  • Original Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Over the last years, intraoperative use of fluorescein is gaining ground in the field of neurosurgery, due to development of a microscope-integrated YELLOW 560 module, with reported experiences in brain malignancies, aneurysms, and arteriovenous malformation surgery.

The aim of this study is to determine the feasibility and value of fluorescein videoangiography during bypass procedures.

Methods

The authors enrolled 11 patients who underwent extracranial-to-intracranial bypass for moyamoya disease, atherosclerotic steno-occlusive cerebrovascular disease, and flow replacement during a giant middle cerebral artery (MCA) aneurysm treatment. Patients underwent fluorescein videoangiography using microscope-integrated fluorescence module.

Results

In all 11 cases, good bypass patency was intraoperatively demonstrated through fluorescein videoangiography and confirmed by post-operative digital subtraction angiography or computed tomographic angiography. The technique seems to be less sensible than standard indocyanine green videoangiography in terms of flow velocity assessment during first pass and does not benefit from a dedicated software to perform hemodynamic parameter analysis (i.e., FLOW 800). Fluorescein videoangiography was able to show a higher number of vessels than indocyanine green videoangiography, providing an extremely well-defined view of cortical vascular network, also in deeper cortical areas. In case of deep-seated anastomosis, it allowed real-time manipulation of neurovascular structures, making it possible a safe analysis of vessels in deep surgical field during videoangiography observation.

Conclusions

Fluorescein videoangiography is a cost-effective, easy-to-use, fast and safe intraoperative tool and is useful to assess graft patency and extent of cortical vascular network also in deeper cortical areas. In case of deep-seated anastomosis, it provides the great advantage of performing real-time manipulation of neurovascular structures during videoangiography observation. It could represent a valuable complementary or alternative technique to assess intraoperative bypass function.

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Abbreviations

ICG:

Indocyanine green

STA:

Superficial temporal artery

MCA:

Middle cerebral artery

MMD:

Moyamoya disease

ACVD:

Atherosclerotic steno-occlusive cerebrovascular disease

DSA:

Digital subtraction angiography

MR:

Magnetic resonance

CBF:

Cerebral blood flow

SPECT:

Single-photon emission tomography

PET:

Positron emission tomography

CTA:

Computed tomographic angiography

MRA:

Magnetic resonance angiography

ECA:

External carotid artery

EMS:

Encephalo-myo-synangiosis

EDS:

Encephalo-duro-synangiosis

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Authors and Affiliations

  1. Department of Neurosurgery, Charitè-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Alessandro Narducci, Julia Onken, Marcus Czabanka, Nils Hecht & Peter Vajkoczy

Authors
  1. Alessandro Narducci
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  2. Julia Onken
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  3. Marcus Czabanka
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  4. Nils Hecht
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  5. Peter Vajkoczy
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Corresponding author

Correspondence to Peter Vajkoczy.

Ethics declarations

All procedures performed in this study 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. All patients signed an informed consent form prior to the surgical procedure; patients undergoing sodium fluorescein administration signed a specific consent form. For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflict of interest.

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Narducci, A., Onken, J., Czabanka, M. et al. Fluorescein videoangiography during extracranial-to-intracranial bypass surgery: preliminary results. Acta Neurochir 160, 767–774 (2018). https://doi.org/10.1007/s00701-017-3453-0

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  • DOI: https://doi.org/10.1007/s00701-017-3453-0

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