Novel software-derived workflow in extracranial–intracranial bypass surgery validated by transdural indocyanine green videoangiography

P. Dodier, T. Auzinger, G. Mistelbauer, W.T. Wang, H. Ferraz-Leite, A. Gruber, W. Marik, F. Winter, G. Fischer, J.M. Frischer, G. Bavinzski, World Neurosurgery (n.d.).

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Abstract
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: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: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:Our clinical results have validated the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.
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2019-11-14
Journal Title
World Neurosurgery
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Dodier P, Auzinger T, Mistelbauer G, et al. Novel software-derived workflow in extracranial–intracranial bypass surgery validated by transdural indocyanine green videoangiography. World Neurosurgery. doi:10.1016/j.wneu.2019.11.038
Dodier, P., Auzinger, T., Mistelbauer, G., Wang, W. T., Ferraz-Leite, H., Gruber, A., … Bavinzski, G. (n.d.). Novel software-derived workflow in extracranial–intracranial bypass surgery validated by transdural indocyanine green videoangiography. World Neurosurgery. https://doi.org/10.1016/j.wneu.2019.11.038
Dodier, Philippe, Thomas Auzinger, Gabriel Mistelbauer, Wei Te Wang, Heber Ferraz-Leite, Andreas Gruber, Wolfgang Marik, et al. “Novel Software-Derived Workflow in Extracranial–Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography.” World Neurosurgery, n.d. https://doi.org/10.1016/j.wneu.2019.11.038.
P. Dodier et al., “Novel software-derived workflow in extracranial–intracranial bypass surgery validated by transdural indocyanine green videoangiography,” World Neurosurgery.
Dodier P, Auzinger T, Mistelbauer G, Wang WT, Ferraz-Leite H, Gruber A, Marik W, Winter F, Fischer G, Frischer JM, Bavinzski G. Novel software-derived workflow in extracranial–intracranial bypass surgery validated by transdural indocyanine green videoangiography. World Neurosurgery.
Dodier, Philippe, et al. “Novel Software-Derived Workflow in Extracranial–Intracranial Bypass Surgery Validated by Transdural Indocyanine Green Videoangiography.” World Neurosurgery, Elsevier, doi:10.1016/j.wneu.2019.11.038.

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