Medical Student Renaissance School of Medicine at Stony Brook University
Introduction: Indocyanine green video angiography (ICG-VA) is a non-invasive technique to assess blood flow during cerebrovascular surgery. ICG-VA provides real time information with arterial, capillary, and venous phases. During bypass and revascularization procedures ICG-VA is used for verification of the patency of anastomosis. In this report we present our experience interpreting the venous phase of ICG-VA in direct STA-MCA bypass procedures as a possible predictor of postoperative hyperperfusion.
Methods: Between January 2024 and October 2024, 25 patients underwent 28 STA-MCA bypass procedures. During the acute postoperative period, 5 (18%) patients developed cerebral hyperperfusion syndrome (CHS) confirmed based on clinical and imaging findings. Indication for revascularization was Moyamoya disease in 4 patients, and atherosclerotic middle cerebral artery occlusion in 1 patient. Arterial, capillary and venous phases of ICG-VA recorded during surgery were analyzed retrospectively. Change in direction of cortical venous drainage to Sylvian versus superior or inferior anastomosing veins was recorded.
Results: In 3/5 (60%) patients with CHS there was change in direction of cortical venous outflow while this was the case in 3/23 (13%) patients who had no clinical or imaging evidence of hyperperfusion.
Conclusion : Congestion of cortical venous drainage demonstrated by change in the direction of outflow might be a predictor of CHS. Prospective studies with larger sample sizes are needed to validate our results.
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