[Application of indocyanine green angiography in bypass surgery for moyamoya disease]

Area of Science:

• Neurosurgery
• Vascular Surgery
• Medical Imaging

Background:

• Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by progressive stenosis of the internal carotid arteries.
• Bypass surgery is a crucial treatment for MMD, aiming to restore cerebral blood flow.
• Accurate intraoperative assessment of bypass graft patency is essential for surgical success.

Purpose of the Study:

• To evaluate the utility and effectiveness of intraoperative indocyanine green angiography (ICGA) in bypass surgery for moyamoya disease.
• To assess ICGA's ability to provide real-time information on bypass graft patency and identify potential complications.

Main Methods:

• A prospective study involving 37 patients with moyamoya disease undergoing bypass surgery.
• Intraoperative ICGA was performed using a surgical microscope with integrated near-infrared illumination and fluorescence recording.
• Findings from ICGA were compared with postoperative digital subtraction angiography (DSA) for validation.

Main Results:

• ICGA provided excellent visualization of cerebral arteries and significantly influenced surgical decisions.
• The technique successfully identified two non-patent superficial temporal artery-middle cerebral artery (STA-MCA) bypasses, which were revised.
• Postoperative DSA confirmed the accuracy of ICGA findings in all cases.

Conclusions:

• Intraoperative ICGA is a reliable and rapid method for assessing bypass graft patency during moyamoya disease surgery.
• ICGA's high spatial resolution aids in detecting anastomotic site stenoses or vascular obstructions.
• This angiography technique serves as a valuable tool for intraoperative evaluation, enhancing surgical outcomes in MMD.