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  • Title: Safe and accurate sylvian dissection with the use of indocyanine green videoangiography.
    Author: Kubota H, Sanada Y, Nagatsuka K, Yoshioka H, Iwakura M, Kato A.
    Journal: Surg Neurol Int; 2016; 7(Suppl 14):S427-9. PubMed ID: 27313972.
    Abstract:
    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. CONCLUSION: 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.
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