• Philippe Dodier, Thomas Auzinger, Gabriel Mistelbauer, Wei-Te Wang, Heber Ferraz-Leite, Andreas Gruber, Wolfgang Marik, Fabian Winter, Gerrit Fischer, Josa M Frischer, and Gerhard Bavinzski.
• Department of Neurosurgery, Medical University Vienna, Vienna, Austria. Electronic address: philippe.dodier@meduniwien.ac.at.
• World Neurosurg. 2020 Feb 1; 134: e892-e902.

BackgroundThe introduction of image-guided methods to bypass surgery has resulted in optimized preoperative identification of the recipients and excellent patency rates. However, the recently presented methods have also been resource-consuming. In the present study, we have reported a cost-efficient planning workflow for extracranial-intracranial (EC-IC) revascularization combined with transdural indocyanine green videoangiography (tICG-VA).MethodsWe performed a retrospective review at a single tertiary referral center from 2011 to 2018. A novel software-derived workflow was applied for 25 of 92 bypass procedures during the study period. The precision and accuracy were assessed using tICG-VA identification of the cortical recipients and a comparison of the virtual and actual data. The data from a control group of 25 traditionally planned procedures were also matched.ResultsThe intraoperative transfer time of the calculated coordinates averaged 0.8 minute (range, 0.4-1.9 minutes). The definitive recipients matched the targeted branches in 80%, and a neighboring branch was used in 16%. Our workflow led to a significant craniotomy size reduction in the study group compared with that in the control group (P = 0.005). tICG-VA was successfully applied in 19 cases. An average of 2 potential recipient arteries were identified transdurally, resulting in tailored durotomy and 3 craniotomy adjustments. Follow-up patency results were available for 49 bypass surgeries, comprising 54 grafts. The overall patency rate was 91% at a median follow-up period of 26 months. No significant difference was found in the patency rate between the study and control groups (P = 0.317).ConclusionsOur clinical results have validated the presented planning and surgical workflow and support the routine implementation of tICG-VA for recipient identification before durotomy.Copyright © 2019 Elsevier Inc. All rights reserved.

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