gms | German Medical Science

Objective: The introduction of image-guided methods in bypass surgery resulted in optimized preoperative identification of recipients and in excellent patency rates, but recently presented methods are also resource-consuming. The objective was to present a cost-efficient planning workflow in extracranial-intracranial (EC-IC) revascularization in combination with transdural indocyanine green videoangiography (tICG-VA).

Methods: The study was a retrospective review at a single tertiary referral center from 2011 to 2018. A novel software-derived workflow was applied in 25 of 92 bypass procedures between 2011 and 2018. Precision and accuracy were assessed through tICG-VA identification of cortical recipients and by comparison of virtual and actual data. A control group of 25 traditionally planned procedures was additionally matched.

Results: Intraoperative transfer time of calculated coordinates averaged 0.8 min (0.4-1.9 min). 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 to the control group (p=.005). tICG-VA was successfully applied in 19 cases. An average of two potential recipient arteries were identified transdurally, resulting in tailored durotomies 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 time of 26 months. No significant difference was found in the patency rate between both groups (p=.317).

Conclusion: Our clinical results validate the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.