Intraoperative infrared fluorescence angiography in surgery of peripheral nerve injuries
- Authors: Svistov D.V.1, Isaev D.M.1, Gaivoronskiy A.I.1,2, Churikov L.I.1, Belyakov K.V.1
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Affiliations:
- Military Medical Academy named after S.M. Kirov
- Saint Petersburg State University
- Issue: Vol 23, No 1 (2021)
- Pages: 59-66
- Section: Clinical trials
- URL: https://journals.rcsi.science/1682-7392/article/view/61378
- DOI: https://doi.org/10.17816/brmma61378
- ID: 61378
Cite item
Abstract
Often, when performing reconstruction of nerve trunks, between the ends of the damaged nerve, the presence of diastasis is noted, which requires significant nerve tension in order to overcome it. This, in turn, can lead to a violation of the blood supply to the nerve and damage to its ultrastructures, which leads to unsatisfactory treatment results. The possibility of using intraoperative infrared fluorescence angiography in reconstructive surgical interventions for peripheral nerve damage, in order to assess the degree of blood flow disturbance in the nerve trunk, is considered. In patients with a complete anatomical break during the operation, an attempt was made to overcome diastasis by measuring the tension force (up to 3 N) with which the nerve was affected. Infrared fluorescence angiography with indocyanine green was performed simultaneously. The obtained angiograms were analyzed, and the effect of the tension force on the change in blood flow in the nerve trunk was determined. It was found that when exposed to a force of up to 2 N, there is no significant change in the intraneural blood flow. At the same time, the effect of a force of 3 N is manifested on angiograms by a significant decrease in the volume of blood flow, which is usually due to constriction of the vessels due to their stretching. After reconstruction (microsurgical epineural suture), repeated angiography was performed to assess the safety and adequacy of blood supply to the nerve. It was revealed that the use of intraopreational angiography with indocyanin green is an affordable and easily feasible technique that allows to determine the safety and, equally important, the adequacy and efficiency of blood flow in the nerve trunk. This technique makes it possible to monitor the safety of blood flow in the nerve trunk, to study the mechanisms of compensation of blood supply to the nerve after microsurgical epineural suture, to assess the quality of comparison of nerve stumps along the axis, excluding the possibility of their "twist".
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##article.viewOnOriginalSite##About the authors
Dmitriy V. Svistov
Military Medical Academy named after S.M. Kirov
Email: dvsvistov@mail.ru
ORCID iD: 0000-0002-3922-9887
Candidate of Medical Sciences, Head of the Department, Department of Neurosurgery
Russian Federation, Saint PetersburgDzhamaludin M. Isaev
Military Medical Academy named after S.M. Kirov
Email: isaev.neuro@mail.ru
ORCID iD: 0000-0003-3336-3230
Lecturer
Russian Federation, Saint PetersburgAleksey I. Gaivoronskiy
Military Medical Academy named after S.M. Kirov; Saint Petersburg State University
Author for correspondence.
Email: don-gaivoronsky@ya.ru
ORCID iD: 0000-0003-1886-5486
Doctor of medical sciences, professor
Russian Federation, Saint Petersburg; Saint PetersburgLeonid I. Churikov
Military Medical Academy named after S.M. Kirov
Email: leon-doc89@mail.ru
ORCID iD: 0000-0002-4982-7848
Сandidate of medical sciences
Russian Federation, Saint PetersburgKirill V. Belyakov
Military Medical Academy named after S.M. Kirov
Email: belaykoff@mail.ru
Candidate of medical sciences
Russian Federation, Saint PetersburgReferences
- Goven’ko FS. Khirurgiya povrezhdenii perifericheskikh nervov. Sankt-Peterburg: Feniks; 2010. (In Russ).
- Boroda YuI. Vybor rekonstruktivnoj operacii na nerve v zavisimosti ot stepeni natjazhenija v zone shva. Genij ortopedii. 2000;(2):32–33. (In Russ).
- Peng TH, Ding HM, Chen SH, et al. Demonstration of three injection methods for the analysis of extrinsic and intrinsic blood supply of the peripheral nerve. Surg Radiol Anat. 2009;31(8):567–571. doi: 10.1007/s00276-009-0480-4
- Reinhold AK, Rittner HL. Barrier function in the peripheral and central nervous system – a review. Pflügers Archiv: European journal of physiology. 2017;469(1):123–134. doi: 10.1007/s00424-016-1920-8
- Mizisin AP, Weerasuriya A. Homeostatic regulation of the endoneurial microenvironment during development, aging and in response to trauma, disease and toxic insult. Acta Neuropathol. 2011;121(3):291–312. doi: 10.1007/s00401-010-0783-x
- Lundborg G. The intrinsic vascularization of human peripheral nerves: structural and functional aspects. J Hand Surg Am. 1979;4(1):34–41. doi: 10.1016/s0363-5023(79)80102-1
- Feindel W., Yamamoto Y.L., Hodge C.P. Intracarotid fluoresce in angiography: a new method for examination of the epicerebral circulation in man. CMAJ. 1967;96(1):1–7.
- Wrobel CJ, Meltzer H, Lamond R, Alksne JF. Intraoperative Assessment of Aneurysm Clip Placement by Intravenous Fluorescein Angiography. Neurosurgery. 1994;35(5):970–973. doi: 10.1097/00006123-199411000-00027
- Eliava ShSh, Shektman OD, Pilipenko IuV., et al. Intraoperative indocyanine green fluorescence angiography in surgery of brain aneurysms. The first experience with using the technique and literature review. Voprosy neirokhirurgii imeni NN Burdenko. 2015;79(1):33–41. (In Russ). doi: 10.17116/neiro201579133-41
- Munabi NC, Olorunnipa OB, Goltsman D, et al. The ability of intra-operative perfusion mapping with laser-assisted indocyanine green angiography to predict mastectomy flap necrosis in breast reconstruction: A prospective trial. J Plast Reconstr Aesthet Surg. 2014;67(4):449–455. doi: 10.1016/j.bjps.2013.12.040
- Newman MI, Samson MС, Tamburrino JF, et al. An investigation of the application of laser-assisted indocyanine green fluorescent dye angiography in pedicle transverse rectus abdominus myocutaneous breast. Canadian Journal of Plastic Surgery. 2011;19(1):1–5. doi: 10.1177/229255031101900101
- Churikov LI. Variantnaya anatomiya luchevogo nerva i osobennosti operativnykh vmeshatel’stv pri ego povrezhdeniyakh. [dissertation] Saint Petersburg; 2018. (In Russ).
- Churikov LI, Gayvoronsky AI, Gayvoronsky IV, et al. Influence of the dosed treatment and mobilization on structures of the radial nerve in the region of shoulder. Rossiiskii neirokhirurgicheskii zhurnal im. professora A.L. Polenova. 2017;9(3):33–40.(In Russ).
- Alyaev YuG, Bezrukov EA, Sirota ES, Morozov AO. Indocyanine green fluorescent imaging in urology. Urologiya. 2016;(1):106–111. (In Russ).
- Tsujino Y, Mizumoto K, Matsuzaka Y. Fluorescence navigation with indocyanine green for detecting sentinel nodes in extramammary Paget’s disease and squamous cell carcinoma. J Dermatol. 2009;36(2):90–94. doi: 10.1111/j.1346-8138.2009.00595.x
- Koshima I, Moriguchi T, Soeda S. Reinnervation of denervated Pacinian corpuscles: ultrastructural observations in rats following free nerve grafts. Plast Reconstr Surg. 1993;92(4):728–735. doi: 10.1097/00006534-199309001-00025
- Tanaka K, Okazaki M, Yano T, et al. Quantitative evaluation of blood perfusion to nerves included in the anterolateral thigh flap using indocyanine green fluorescence angiography: a different contrast pattern between the vastus lateralis motor nerve and femoral cutaneous nerve. J Reconstr Microsurg. 2015;31(3):163–170. doi: 10.1055/s-0034-1390382
- Caillaud M, Richard L, Vallat JM, et al. Peripheral nerve regeneration and intraneural revascularization. Neural Regen Res. 2019;14(1):24–33. doi: 10.4103/1673-5374.243699