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Correct Plane of the Sylvian Vein Dissection for Middle Cerebral Artery Aneurysm Using Indocyanine Green Videoangiography.
- Source :
-
World neurosurgery [World Neurosurg] 2017 Jan; Vol. 97, pp. 453-458. Date of Electronic Publication: 2016 Oct 11. - Publication Year :
- 2017
-
Abstract
- Background: Preservation of the superficial Sylvian veins (SSVs) is essential to prevent neurologic deficits during Sylvian dissection. We describe an appropriate surgical approach for unruptured middle cerebral artery (MCA) aneurysms to preserve these veins by using indocyanine green videoangiography (ICG-VA).<br />Methods: Between August 2014 and August 2015, we performed microsurgical clipping for 37 unruptured MCA aneurysms in 36 patients. We classified all of the cases into 3 types according to the location between the Sylvian fissure and the SSV. We defined 3 surgical approaches (frontosylvian, intersylvian, and temporo-sylvian) based on the SSV and investigated the proper surgical approach according to the type of case.<br />Results: In our study, most SSVs were located above the Sylvian fissure (fissure type, 64.9%). The SSV was located on the temporal lobe in 10 cases (temporal type) and on the frontal lobe in 3 cases (frontal type). The frontosylvian approach (splitting between the SSV and frontal lobe) was performed in all of the patients with temporal type; the temporo-sylvian approach (splitting between the SSV and temporal lobe) was performed in all of the patients with frontal type and single SSV of fissure type. The intersylvian approach (splitting between the frontal and temporal SSV, or among multiple SSVs) was successfully performed in the patients with double or multiple SSVs of fissure type. No venous complications occurred that were related to the surgical approach.<br />Conclusions: Correct dissection strategy using intraoperative ICG-VA is greatly useful to define the optimal surgical approach without vein injury.<br /> (Copyright © 2016. Published by Elsevier Inc.)
- Subjects :
- Adult
Aged
Cerebral Veins pathology
Contrast Media
Female
Humans
Indocyanine Green
Male
Middle Aged
Treatment Outcome
Video-Assisted Surgery
Cerebral Angiography methods
Cerebral Veins surgery
Dissection methods
Intracranial Aneurysm pathology
Intracranial Aneurysm surgery
Surgery, Computer-Assisted methods
Subjects
Details
- Language :
- English
- ISSN :
- 1878-8769
- Volume :
- 97
- Database :
- MEDLINE
- Journal :
- World neurosurgery
- Publication Type :
- Academic Journal
- Accession number :
- 27742507
- Full Text :
- https://doi.org/10.1016/j.wneu.2016.09.128