title: Correct Plane of the Sylvian Vein Dissection for Middle Cerebral Artery Aneurysm Using Indocyanine Green Videoangiography.
abstract: BACKGROUND
  Preservation of the superficial Sylvian veins (SSVs) is essential to prevent neurologic deficits during Sylvian dissection. We describe an appropriate surgical approach for unruptured middle cerebral artery (MCA) aneurysms to preserve these veins by using indocyanine green videoangiography (ICG-VA).
  
  
  METHODS
  Between August 2014 and August 2015, we performed microsurgical clipping for 37 unruptured MCA aneurysms in 36 patients. We classified all of the cases into 3 types according to the location between the Sylvian fissure and the SSV. We defined 3 surgical approaches (frontosylvian, intersylvian, and temporo-sylvian) based on the SSV and investigated the proper surgical approach according to the type of case.
  
  
  RESULTS
  In our study, most SSVs were located above the Sylvian fissure (fissure type, 64.9%). The SSV was located on the temporal lobe in 10 cases (temporal type) and on the frontal lobe in 3 cases (frontal type). The frontosylvian approach (splitting between the SSV and frontal lobe) was performed in all of the patients with temporal type; the temporo-sylvian approach (splitting between the SSV and temporal lobe) was performed in all of the patients with frontal type and single SSV of fissure type. The intersylvian approach (splitting between the frontal and temporal SSV, or among multiple SSVs) was successfully performed in the patients with double or multiple SSVs of fissure type. No venous complications occurred that were related to the surgical approach.
  
  
  CONCLUSIONS
  Correct dissection strategy using intraoperative ICG-VA is greatly useful to define the optimal surgical approach without vein injury.
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Sung-Pil
authors.initials: SP
authors.lastname: Joo
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Seung-Hoon
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea.
authors.forename: Sung-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea. Electronic address: taesun1963@yahoo.co.kr.
authors.forename: Tae-Sun
authors.initials: TS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002550:Cerebral Veins / Q000473:pathology / Q000601:surgery*; D003287:Contrast Media; D004210:Dissection / Q000379:methods*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: D003287:Contrast Media; D007208:Indocyanine Green
keywords: Indocyanine green videoangiography; Middle cerebral artery aneurysm; Sylvian dissection; superficial Sylvian veins