Novel Software-Derived Workflow in Extracranial-Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography.
Adolescent
Adult
Aged
Carotid Artery, Internal, Dissection
/ surgery
Carotid Stenosis
/ surgery
Cerebral Angiography
Cerebral Revascularization
/ methods
Coloring Agents
Craniotomy
/ methods
Dura Mater
/ surgery
Female
Humans
Indocyanine Green
Male
Middle Aged
Middle Cerebral Artery
/ surgery
Moyamoya Disease
/ surgery
Retrospective Studies
Software
Surgery, Computer-Assisted
/ methods
Temporal Arteries
/ surgery
Treatment Outcome
Workflow
Young Adult
Cerebral revascularization
EC–IC bypass surgery
Flow augmentation
Flow replacement
STA-MCA bypass
Transdural ICG-VA
Virtual planning
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
24
08
2019
revised:
05
11
2019
accepted:
06
11
2019
pubmed:
17
11
2019
medline:
11
3
2020
entrez:
17
11
2019
Statut:
ppublish
Résumé
The introduction of image-guided methods to bypass surgery has resulted in optimized preoperative identification of the recipients and excellent patency rates. However, the recently presented methods have also been resource-consuming. In the present study, we have reported a cost-efficient planning workflow for extracranial-intracranial (EC-IC) revascularization combined with transdural indocyanine green videoangiography (tICG-VA). We performed a retrospective review at a single tertiary referral center from 2011 to 2018. A novel software-derived workflow was applied for 25 of 92 bypass procedures during the study period. The precision and accuracy were assessed using tICG-VA identification of the cortical recipients and a comparison of the virtual and actual data. The data from a control group of 25 traditionally planned procedures were also matched. The intraoperative transfer time of the calculated coordinates averaged 0.8 minute (range, 0.4-1.9 minutes). The definitive recipients matched the targeted branches in 80%, and a neighboring branch was used in 16%. Our workflow led to a significant craniotomy size reduction in the study group compared with that in the control group (P = 0.005). tICG-VA was successfully applied in 19 cases. An average of 2 potential recipient arteries were identified transdurally, resulting in tailored durotomy and 3 craniotomy adjustments. Follow-up patency results were available for 49 bypass surgeries, comprising 54 grafts. The overall patency rate was 91% at a median follow-up period of 26 months. No significant difference was found in the patency rate between the study and control groups (P = 0.317). Our clinical results have validated the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.
Sections du résumé
BACKGROUND
BACKGROUND
The introduction of image-guided methods to bypass surgery has resulted in optimized preoperative identification of the recipients and excellent patency rates. However, the recently presented methods have also been resource-consuming. In the present study, we have reported a cost-efficient planning workflow for extracranial-intracranial (EC-IC) revascularization combined with transdural indocyanine green videoangiography (tICG-VA).
METHODS
METHODS
We performed a retrospective review at a single tertiary referral center from 2011 to 2018. A novel software-derived workflow was applied for 25 of 92 bypass procedures during the study period. The precision and accuracy were assessed using tICG-VA identification of the cortical recipients and a comparison of the virtual and actual data. The data from a control group of 25 traditionally planned procedures were also matched.
RESULTS
RESULTS
The intraoperative transfer time of the calculated coordinates averaged 0.8 minute (range, 0.4-1.9 minutes). The definitive recipients matched the targeted branches in 80%, and a neighboring branch was used in 16%. Our workflow led to a significant craniotomy size reduction in the study group compared with that in the control group (P = 0.005). tICG-VA was successfully applied in 19 cases. An average of 2 potential recipient arteries were identified transdurally, resulting in tailored durotomy and 3 craniotomy adjustments. Follow-up patency results were available for 49 bypass surgeries, comprising 54 grafts. The overall patency rate was 91% at a median follow-up period of 26 months. No significant difference was found in the patency rate between the study and control groups (P = 0.317).
CONCLUSIONS
CONCLUSIONS
Our clinical results have validated the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.
Identifiants
pubmed: 31733380
pii: S1878-8750(19)32874-8
doi: 10.1016/j.wneu.2019.11.038
pii:
doi:
Substances chimiques
Coloring Agents
0
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e892-e902Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.