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DOI: 10.1055/s-0041-1725026
Multimodal Microvascular Mapping for Head and Neck, Skull Base Research and Education: An Anatomical Donor Study
Funding This study was funded by Boston University Department of Otolaryngology—Head and Neck Surgery, Boston University Department of Anatomy and Neurobiology, and the Julia & Seymour Gross Foundation, Inc.Abstract
Objective This study was aimed to develop a method combining computed tomography (CT) and fluorescence imaging, allowing identification of microvasculature in anatomical donors and facilitating translational research and education.
Methods We investigated homogeneity and radiopacity of 30 different mixtures including radiopaque substances povidone–iodine (Betadine), barium sulfate (BaSO4), and bismuth subsalicylate (Pepto-Bismol) varying in suspension and dilution with agar, latex, or gelatin. Three candidate mixtures were selected for testing the extent of perfusion in renal vasculature to establish methodology. From these candidate mixtures, two were selected for mixture with fluorescein and infusion into cadavers based on their ability to perfuse renal vasculature. The extent to which these two candidate mixtures combined with fluorescein were able to perfuse vasculature in a cadaver head was used to determine which mixture was superior.
Results BaSO4 and bismuth subsalicylate–based mixtures demonstrated superior opacity in vials. In terms of solidifying agents, gelatin-based mixtures demonstrated increased friability and lower melting points compared with the other agents, so only latex and agar-based mixtures were used moving forward past the vial stage. Combinations of BaSO4 and latex and BaSO4 and 3% agar were found to perfuse kidneys superiorly to the mixture containing bismuth subsalicylate. Finally, in cadaver heads, the mixture containing BaSO4, agar, and fluorescein was found to perfuse the smallest vasculature.
Conclusion A final combination of BaSO4, 3% agar, and fluorescein proves to be a powerful and novel combination enabling CT imaging, fluorescence imaging, and dissection of vasculature. This paves the way for future translational research and education.
Publication History
Received: 05 July 2020
Accepted: 13 January 2021
Article published online:
01 March 2021
© 2021. Thieme. All rights reserved.
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References
- 1 Bisicchia S, Rosso F, Pizzimenti MA, Rungprai C, Goetz JE, Amendola A. Injury risk to extraosseous knee vasculature during osteotomies: a cadaveric study with CT and dissection analysis. Clin Orthop Relat Res 2015; 473 (03) 1030-1039
- 2 Cilliers K, Page BJ. Detailed description of the anterior cerebral artery anomalies observed in a cadaver population. Ann Anat 2016; 208: 1-8
- 3 Ross S, Spendlove D, Bolliger S. et al. Postmortem whole-body CT angiography: evaluation of two contrast media solutions. AJR Am J Roentgenol 2008; 190 (05) 1380-1389
- 4 Tokairin Y, Nakajima Y, Nagai K, Yamaguchi K, Akita K, Kinugasa Y. Aortic inflation with agar injection is a useful method of cadaveric preparation which creates a mediastinal anatomy that better mimics the living body for surgical training. Gen Thorac Cardiovasc Surg 2019
- 5 Kelly CP, Yavuzer R, Keskin M, Bradford M, Govila L, Jackson IT. Functional anastomotic relationship between the supratrochlear and facial arteries: an anatomical study. Plast Reconstr Surg 2008; 121 (02) 458-465
- 6 Reece EM, Schaverien M, Rohrich RJ. The paramedian forehead flap: a dynamic anatomical vascular study verifying safety and clinical implications. Plast Reconstr Surg 2008; 121 (06) 1956-1963
- 7 Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg 2008; 122 (01) 161-170
- 8 Schaverien MV, Pessa JE, Saint-Cyr M, Rohrich RJ. The arterial and venous anatomies of the lateral face lift flap and the SMAS. Plast Reconstr Surg 2009; 123 (05) 1581-1587
- 9 Sedlmayr JC, Witmer LM. Rapid technique for imaging the blood vascular system using stereoangiography. Anat Rec 2002; 267 (04) 330-336
- 10 Tennant JN, Rungprai C, Pizzimenti MA. et al. Risks to the blood supply of the talus with four methods of total ankle arthroplasty: a cadaveric injection study. J Bone Joint Surg Am 2014; 96 (05) 395-402
- 11 Burggasser G, Happak W, Gruber H, Freilinger G. The temporalis: blood supply and innervation. Plast Reconstr Surg 2002; 109 (06) 1862-1869
- 12 Morsy M, Sur YJ, Akdag O. et al. Anatomic and high-resolution computed tomographic angiography study of the lateral femoral condyle flap: Implications for surgical dissection. J Plast Reconstr Aesthet Surg 2018; 71 (01) 33-43
- 13 Settembre N, Labrousse M, Magnan PE. et al. Surgical anatomy of the right gastro-omental artery: a study on 100 cadaver dissections. Surg Radiol Anat 2018; 40 (04) 415-422
- 14 Almoumen Z, AlQahtani S, Albaharna H. Patency of the nasolacrimal drainage system after power-assisted medial flap turbinoplasty. Laryngoscope Investig Otolaryngol 2019; 4 (02) 218-221
- 15 Romano-Feinholz S, Alcocer-Barradas V, Benítez-Gasca A, Martínez-de la Maza E, Valencia-Ramos C, Gómez-Amador JL. Hybrid fluorescein-guided surgery for pituitary adenoma resection: a pilot study. J Neurosurg 2019; 132 (05) 1490-1498
- 16 Schebesch KM, Rosengarth K, Brawanski A. et al. Clinical benefits of combining different visualization modalities in neurosurgery. Front Surg 2019; 6: 56
- 17 Vetrano IG, Acerbi F, Falco J. et al. Fluorescein-guided removal of peripheral nerve sheath tumors: a preliminary analysis of 20 cases. J Neurosurg 2019; (e-pub ahead of print) DOI: 10.3171/2019.9.JNS19970.
- 18 Beckler AD, Ezzat WH, Seth R, Nabili V, Blackwell KE. Assessment of fibula flap skin perfusion in patients undergoing oromandibular reconstruction: comparison of clinical findings, fluorescein, and indocyanine green angiography. JAMA Facial Plast Surg 2015; 17 (06) 422-426
- 19 Moris V, Cristofari S, Stivala A. et al. Fluorescent indocyanine green angiography: Preliminary results in microsurgery monitoring. J Stomatol Oral Maxillofac Surg 2019; 120 (04) 297-300
- 20 Pestana IA, Coan B, Erdmann D, Marcus J, Levin LS, Zenn MR. Early experience with fluorescent angiography in free-tissue transfer reconstruction. Plast Reconstr Surg 2009; 123 (04) 1239-1244