title: Indocyanine green videoangiography for the identification of superficial temporal artery branches in EC-IC bypass surgery.
abstract: BACKGROUND
  Superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass remains an essential tool for managing complex cerebrovascular conditions. A crucial surgical step is the identification and safe dissection of the bypass donor artery. If the frontal branch of the STA is used, a curvilinear fronto-temporal scalp flap generally allows for a clean dissection from the underside of the scalp flap. This dissection is sometimes tedious, since the frontal branch is not always easily visible and due to variability of its anatomy. With this article, we report on the feasibility and effectiveness of a simple indocyanine green videoangiography (ICG-VA)-assisted technique for the identification of the STA branches from the underside of a fronto-temporal scalp flap in bypass surgery.
  
  
  METHODS
  The technique is based on the analysis of the difference in timing of filling of scalp vessels illuminated via ICG-VA from the underside of a scalp flap. Three illustrative cases are reported.
  
  
  RESULTS
  ICG-VA permitted the correct identification and safe dissection of the donor vessels (STA branches) in all three patients. There were no complications due to the ICG-VA.
  
  
  CONCLUSIONS
  This technique allows reliable visualization of the STA and its branches at once before microsurgical dissection. The information provided by ICG-VA enables precise mapping and preparation of the STA. The simplicity and safety of this technique make it an effective tool for intraoperative identification of the STA and its branches.
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091. giuseppe.esposito@usz.ch.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Esposito
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091. jan-karl.burkhardt@usz.ch.
authors.forename: Jan-Karl
authors.initials: JK
authors.lastname: Burkhardt
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091. oliver.bozinov@usz.ch.
authors.forename: Oliver
authors.initials: O
authors.lastname: Bozinov
authors.affiliation: Department of Neurosurgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland, Frauenklinikstrasse 10, 8091. luca.regli@usz.ch.
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
mesh_terms: D000328:Adult; D002533:Cerebral Angiography / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013699:Temporal Arteries / Q000601:surgery*
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Donor artery; EC-IC bypass; Extra-intracranial bypass; ICG-VA; Indocyanine green videoangiography; STA-MCA bypass