Assessment of collateral venous flow using temporary clip placement at ICG videoangiography
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TECHNICAL NOTE - VASCULAR NEUROSURGERY - OTHER
Assessment of collateral venous flow using temporary clip placement at ICG videoangiography Ridzky Firmansyah Hardian 1 Tetsuyoshi Horiuchi 1
&
Yoshiki Hanaoka 1 & Kohei Funato 1 & Masahiro Agata 1 & Kiyoshi Ito 1 &
Received: 7 May 2020 / Accepted: 9 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background As there are many collateral pathways between venous systems, intraoperative venous injury rarely induces venous infarction. In some patients, however, venous injury during microsurgical manipulation may cause acute and/or delayed serious complications. Although intraoperative evaluation using indocyanine green (ICG) videoangiography is very useful, it is difficult to assess the flow direction using this technique. Method A simple technique using temporary clips and ICG videoangiography was applied to assess the collateral venous pathway in 4 cases of surgical manipulation-related injury or occlusion of the main superficial Sylvian vein in patients with aneurysm. Results The flow direction and collateral pathway can be easily visualized after release of temporary occlusion. Conclusions A collateral venous pathway can be evaluated with the present simple technique described here. Keywords Complication . ICG . Temporary clip . Vein
Introduction Cerebral venous injury during neurosurgery rarely induces venous infarction because there is an extensive anastomosis between cerebral venous systems, which allows drainage via multiple collateral pathways [12]. The bidirectional nature of cerebral venous flow adds to the flexibility of venous flow in pathologic conditions [2, 12]. However, serious complications will develop if no collateral pathway is available. It is important to consider the availability of collateral pathways in cases of venous injury occur before deciding whether venous reconstruction is necessary.
Recently, indocyanine green (ICG) videoangiography has been used routinely to assess the patency of arterial and venous systems intraoperatively [3, 5–8, 11]. Flow stagnation in injured veins can be confirmed easily with routine ICG videoangiography. On the other hand, it is more difficult to evaluate the flow direction of veins than arteries using standard ICG videoangiography. Venous reconstruction should be performed if no collateral pathway is observed. Here, we introduced a new evaluation technique for intraoperative assessment of flow direction in cases of accidental venous injury.
Methods This article is part of the Topical Collection on Vascular Neurosurgery Other Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04617-x) contains supplementary material, which is available to authorized users. * Ridzky Firmansyah Hardian [email protected] 1
Department of Neurosurgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Japan
Assessments of collateral venous flow using temporary clips and ICG videoangiography were performed during
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