{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T22:37:24Z","timestamp":1761345444715,"version":"build-2065373602"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg B Skull Base"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background\u2003Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion.<\/jats:p>\n                  <jats:p>Methods\u2003A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI).<\/jats:p>\n                  <jats:p>Results\u2003A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1\u2009\u00b1\u200928.6 to 114.4\u2009\u00b1\u200932.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3\u2009\u00b1\u200962.8 vs. 118.4\u2009\u00b1\u200929.1, p\u2009=\u20090.003). Transpterygoid approaches showed greater decrease from baseline (\u221225.8\u2009\u00b1\u200958.9 vs. \u22123.8\u2009\u00b1\u200932.1, p\u2009=\u20090.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability.<\/jats:p>\n                  <jats:p>Conclusion\u2003ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.<\/jats:p>","DOI":"10.1055\/s-0044-1792078","type":"journal-article","created":{"date-parts":[[2024,11,5]],"date-time":"2024-11-05T09:52:46Z","timestamp":1730800366000},"page":"e2-e7","source":"Crossref","is-referenced-by-count":0,"title":["Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery"],"prefix":"10.1055","volume":"86","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9619-852X","authenticated-orcid":false,"given":"Rachel","family":"Daum","sequence":"additional","affiliation":[{"name":"Dell Medical School, University of Texas at Austin, Austin, Texas, United States"},{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Grimm","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Yong","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farideh","family":"Hosseinzadeh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine K.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan C.","family":"Fernandez-Miranda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayakar V.","family":"Nayak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zara M.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter H.","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9519-5880","authenticated-orcid":false,"given":"Michael T.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,11,5]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1177\/0194599812443042","article-title":"Minimizing morbidity in endoscopic pituitary surgery: outcomes of the novel nasoseptal rescue flap technique","volume":"147","author":"R B Rawal","year":"2012","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"05","key":"ref2","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1055\/s-0037-1602777","article-title":"Indocyanine green fluorescence to evaluate nasoseptal flap viability in endoscopic endonasal cranial base surgery","volume":"78","author":"E E Kerr","year":"2017","journal-title":"J Neurol Surg B Skull Base"},{"issue":"06","key":"ref3","first-page":"MC01","article-title":"Assessing the viability of Hadad flap by postoperative contrast-enhanced magnetic resonance imaging","volume":"11","author":"H Jyotirmay","year":"2017","journal-title":"J Clin Diagn Res"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/ons\/opy002","article-title":"Evaluation of intranasal flap perfusion by intraoperative indocyanine green fluorescence angiography","volume":"15","author":"M Geltzeiler","year":"2018","journal-title":"Oper Neurosurg (Hagerstown)"},{"issue":"S 02","key":"ref5","first-page":"e492","article-title":"Intraoperative indocyanine green angiography for assessing flap perfusion in skull base reconstruction: a systematic review","volume":"83","author":"N Shaikh","year":"2021","journal-title":"J Neurol Surg B Skull Base"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/s12893-020-00745-4","article-title":"Indocyanine green fluorescence imaging to assess bowel perfusion during totally laparoscopic surgery for colon cancer","volume":"20","author":"H Su","year":"2020","journal-title":"BMC Surg"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1054\/bjps.2002.3969","article-title":"Intraoperative evaluation of skin-flap viability using laser-induced fluorescence of indocyanine green","volume":"55","author":"C Holm","year":"2002","journal-title":"Br J Plast Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3389\/fsurg.2019.00011","article-title":"Indocyanine-green for fluorescence-guided surgery of brain tumors: evidence, techniques, and practical experience","volume":"6","author":"S S Cho","year":"2019","journal-title":"Front Surg"},{"issue":"05","key":"ref9","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1002\/lary.21419","article-title":"Nasoseptal \u201crescue\u201d flap: a novel modification of the nasoseptal flap technique for pituitary surgery","volume":"121","author":"C M Rivera-Serrano","year":"2011","journal-title":"Laryngoscope"},{"issue":"05","key":"ref10","doi-asserted-by":"crossref","first-page":"1463","DOI":"10.3171\/2017.2.JNS161582","article-title":"Nasoseptal flap necrosis: a rare complication of endoscopic endonasal surgery","volume":"128","author":"J D Chabot","year":"2018","journal-title":"J Neurosurg"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"8198","DOI":"10.3390\/ijerph120708198","article-title":"Comparison of regional brain perfusion levels in chronically smoking and non-smoking adults","volume":"12","author":"T C Durazzo","year":"2015","journal-title":"Int J Environ Res Public Health"},{"issue":"08","key":"ref12","doi-asserted-by":"crossref","first-page":"617","DOI":"10.3928\/23258160-20170802-03","article-title":"Evaluation of macular perfusion in healthy smokers by using optical coherence tomography angiography","volume":"48","author":"Z Ayhan","year":"2017","journal-title":"Ophthalmic Surg Lasers Imaging Retina"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"693e","DOI":"10.1097\/PRS.0b013e31828659f4","article-title":"A comparison of free autologous breast reconstruction with and without the use of laser-assisted indocyanine green angiography: a cost-effectiveness analysis","volume":"131","author":"A Chatterjee","year":"2013","journal-title":"Plast Reconstr Surg"},{"issue":"09","key":"ref14","doi-asserted-by":"crossref","first-page":"3014","DOI":"10.1016\/j.bjps.2022.04.050","article-title":"Cost-effectiveness of indocyanine green angiography in postmastectomy breast reconstruction","volume":"75","author":"C L Nguyen","year":"2022","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"12","key":"ref15","doi-asserted-by":"crossref","first-page":"9281","DOI":"10.1007\/s00464-022-09166-1","article-title":"Cost analysis of indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery","volume":"36","author":"R Q Liu","year":"2022","journal-title":"Surg Endosc"}],"container-title":["Journal of Neurological Surgery Part B: Skull Base"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0044-1792078.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T22:31:28Z","timestamp":1761345088000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0044-1792078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,5]]},"references-count":15,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2025,12]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0044-1792078","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["2193-6331","2193-634X"],"issn-type":[{"type":"print","value":"2193-6331"},{"type":"electronic","value":"2193-634X"}],"subject":[],"published":{"date-parts":[[2024,11,5]]}}}