• Fumiaki Fujihara, Toyohiko Isu, Kyongsong Kim, Kimiya Sakamoto, Juntaro Matsumoto, Koichi Miki, Masaki Ito, Masanori Isobe, and Tooru Inoue.
• Department of Neurosurgery, Kushiro Rosai Hospital, Hokkaido, Japan; Department of Neurosurgery, Fukuoka University, Faculty of Medicine, Fukuoka, Japan. Electronic address: midorifugu47@gmail.com.
• World Neurosurg. 2020 Sep 1; 141: 142-148.

BackgroundSurgery for idiopathic tarsal tunnel syndrome (TTS) is of limited effectiveness or ineffective. Using indocyanine green video angiography (ICG-VA), we treated idiopathic TTS by posterior tibial artery (PTA) decompression from the posterior tibial nerve (PTN) and evaluated postoperative patency of the PTA.MethodsWe treated 12 patients (12 feet) with idiopathic TTS by PTA decompression from the PTN and transposed its location. Age range of patients was 70-87 years (mean 77.9 years); all patients were operated on under local anesthesia. After a 2-cm skin incision, the flexor retinaculum was resected, and the PTA was decompressed from the PTN. It was then sutured to the flexor retinaculum for decompression and to prevent compression recurrence. ICG-VA was used to confirm the absence of PTA flow disturbance and to inspect the vasa nervorum of the PTN.ResultsWe encountered no intraoperative or postoperative complications. Postoperatively, ICG-VA confirmed blood flow in the PTA and intactness of the vasa nervorum in all cases. One patient required adjustment of PTA position. All patients reported symptom improvement.ConclusionsOur surgical method of treating idiopathic TTS under ICG-VA monitoring is simple, safe, and effective.Copyright © 2020 Elsevier Inc. All rights reserved.

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