Safe and accurate sylvian dissection with the use of indocyanine green videoangiography.
BACKGROUND
Sylvian dissection is an essential microneurosurgical skill for neurosurgeons. The safe and accurate opening of the sylvian fissure is desirable for a good prognosis.


METHODS
The aim of this report is to demonstrate the use of indocyanine green (ICG) videoangiography to recognize the superficial sylvian vein (SSV) and thus enable a wide opening of the sylvian fissure, especially in patients with subarachnoid hemorrhage (SAH).


RESULTS
The small tributary flowing into the SSV was distinguishable from a passing one, which deeply entered the insula. In addition, an entering point of a tributary to the SSV, which ran perpendicular to the insula, was occasionally determined. SSV, which was barely discernable in a reddish SAH involving the sylvian fissure, was clearly demarcated using ICG videoangiography. Two representative cases of sylvian dissection are herein presented.


CONCLUSIONS
The performance of ICG videoangiography before sylvian dissection is a simple and useful method for identifying a vital approach route for safe and accurate sylvian dissection, and it reduces the risk of causing any accidental injury to the veins in the sylvian fissure.
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Hisashi
H
Kubota
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Yasuhiro
Y
Sanada
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Kazuhiro
K
Nagatsuka
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Hiromasa
H
Yoshioka
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Michihiro
M
Iwakura
Department of Neurosurgery, Kindai University Faculty of Medicine, Osaka, Japan.
Amami
A
Kato
Distal sylvian dissection; indocyanine green videoangiography; superficial sylvian vein