title: "Squeeze Maneuver" Assisted by Indocyanine Green Videoangiography: Simple Technique to "Resuscitate" Partially Occluded Bridging Veins During Microneurosurgical Operations.
abstract: OBJECTIVE
  The preservation of normal peri/intralesional bridging veins is extremely important in every microneurosurgical operation. The purpose of our study was to describe the "squeeze maneuver" assisted by indocyanine green videoangiography (ICGV), a simple technique to "resuscitate" partially occluded bridging veins during microneurosurgical operations.
  
  
  METHODS
  When a bridging vein is inadvertently stretched up to its collapse during microneurosurgical procedures, a precise identification of the partially occluded zone is carried out under high magnification (10-15×), as well as with the aid of the ICGV. If a continuous irrigation with isotonic saline solution does not allow one to reestablish the venous flow, the "squeeze maneuver" is carried out. This consists of squeezing and sliding with the bipolar forceps the occluded vessel along the normal venous flow direction. This procedure is repeated several times, while a continuous saline irrigation is applied. The ICGV is performed to confirm an adequate patency of the vein.
  
  
  RESULTS
  This maneuver permits to restore the normal diameter of the vein and blood flow inside it.
  
  
  CONCLUSIONS
  The "squeeze maneuver" assisted by ICGV represents a safe, clean, fast, and even cheap method for restoring the flow of partially occluded bridging veins during microneurosurgical operations.
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: johchove@hotmail.com.
authors.forename: Joham
authors.initials: J
authors.lastname: Choque-Velasquez
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Colasanti
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery; D008866:Microsurgery / Q000379:methods*; D016343:Monitoring, Intraoperative / Q000379:methods*; D019635:Neurosurgical Procedures / Q000379:methods*; D020535:Video-Assisted Surgery / Q000379:methods*
chemical_list: D007208:Indocyanine Green
keywords: Bridging vein; High magnification; Indocyanine green videoangiography; Microneurosurgery; Squeeze maneuver; Surgical techniques; Venous flow restoration