• Paolo Ferroli, Francesco Acerbi, Giovanni Tringali, Erminia Albanese, Morgan Broggi, Angelo Franzini, and Giovanni Broggi.
• Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy. pferroli@istituto-besta.it
• J. Neurosurg. 2011 Jul 1;115(1):18-23.

ObjectThe purpose of this paper is to evaluate whether venous indocyanine green (ICG) videoangiography has any potential for predicting the presence of a safe collateral circulation for veins that are at risk for intentional or unintentional damage during surgery.MethodsThe authors performed venous ICG videoangiography during 153 consecutive neurosurgical procedures. On those occasions in which a venous sacrifice occurred during surgery, whether that sacrifice was preplanned (intended) or unintended, venous ICG videoangiography was repeated so as to allow us to study the effect of venous sacrifice. A specific test to predict the presence of venous collateral circulation was also applied in 8 of these cases.ResultsVenous ICG videoangiography allowed for an intraoperative real-time flow assessment of the exposed veins with excellent image quality and resolution in all cases. The veins observed in this study were found to be extremely different with respect to flow dynamics and could be divided in 3 groups: 1) arterialized veins; 2) fast-draining veins with uniform filling and clear flow direction; and 3) slow-draining veins with nonuniform filling. Temporary clipping was found to be a simple and reversible way to test for the presence of potential anastomotic circulation.ConclusionsVenous ICG videoangiography is able to reveal substantial variability in the venous flow dynamics. "Slow veins," when they are tributaries of bridging veins, might hide a potential for anastomotic circulation that deserve further investigation.

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