Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions: technical note.

Abstract

Generally, the sacrifice of arteries that perfuse normal brain parenchyma is avoided. However, there are instances when it is necessary to take certain distal arteries to adequately perform tumor resections or secure vascular lesions. Deciding whether the sacrifice of such arteries is safe can be difficult. We present four cases demonstrating the use of indocyanine green (ICG) videoangiography to assess collateral circulation before sacrifice of a distal artery. Two cases involved meningiomas with intimately associated arteries; one case involved a distal middle cerebral artery aneurysm that was not amenable to clip reconstruction, requiring trapping; and another case required complex clip reconstruction of a dysplastic middle cerebral artery aneurysm. In all four cases, ICG videoangiography provided excellent real-time demonstration of sufficient collateral flow and retrograde filling after temporary occlusion of the artery in question. The relevant artery was sacrificed in each case, and all patients did well with no evidence of ischemia. Although this is a limited experience and cannot prove the safety of arterial sacrifice in all situations, our series demonstrates the potential usefulness of ICG videoangiography in assessing collateral arterial flow before sacrifice of distal cerebral arteries.