Near-infrared indocyanine green videoangiography (ICGVA) and intraoperative computed tomography (iCT): are they complementary or competitive imaging techniques in aneurysm surgery?

Abstract Objective: Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries is responsible for ischemic infarction and poor outcome. The goal of this study is to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition, we analyzed the incidence of perforating vessels involved during the aneurysm surgery and the incidence of ischemic infarct caused by compromised small arteries. Methods: Sixty patients with 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co., Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries were analyzed in the microsurgical field during surgical dissection and clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography were considered for analysis. Results: The ICGA was able to visualize flow in all patients in whom perforating vessels were found in the microscope field. Among 36 patients whose perforating vessels were visible on ICGA, 11 (30%) presented a close relation between the aneurysm and perforating arteries. In one (9%) of these 11 patients, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate reestablishment of flow visible with ICGA without clinical consequences. Four patients (6.7%) presented with postoperative perforating artery infarct, three of whom had perforating arteries that were not visible or distant from the aneurysm. Conclusion: The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA may provide visual information with regard to the patency of these small vessels.

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ASSESSMENT OF FLOW IN PERFORATING ARTERIES DURING INTRACRANIAL ANEURYSM SURGERY USING INTRAOPERATIVE NEAR‐INFRARED INDOCYANINE GREEN VIDEOANGIOGRAPHY

Neurosurgery ◽

10.1227/01.neu.0000333795.21468.d4 ◽

2008 ◽

Vol 62 (suppl_3) ◽

pp. ONS-63-ONS-73 ◽

Cited By ~ 31

Author(s):

Jean G. de Oliveira ◽

Jürgen Beck ◽

Volker Seifert ◽

Manoel J. Teixeira ◽

Andreas Raabe

Keyword(s):

Intracranial Aneurysm ◽

Indocyanine Green ◽

Near Infrared ◽

Aneurysm Surgery ◽

Indocyanine Green Videoangiography ◽

Perforating Arteries

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Prospective evaluation of surgical microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery

Journal of Neurosurgery ◽

10.3171/jns.2005.103.6.0982 ◽

2005 ◽

Vol 103 (6) ◽

pp. 982-989 ◽

Cited By ~ 361

Author(s):

Andreas Raabe ◽

Peter Nakaji ◽

Jürgen Beck ◽

Louis J. Kim ◽

Frank P. K. Hsu ◽

...

Keyword(s):

Indocyanine Green ◽

Near Infrared ◽

Video Camera ◽

Aneurysm Surgery ◽

Indocyanine Green Videoangiography ◽

Significant Information ◽

Excitation Light ◽

Content Type ◽

Surgical Microscope ◽

Fine Print

Object. The authors prospectively compared a new technique of surgical microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. Method. The technique was performed during 187 surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating microscope (Carl Zeiss Co., Oberkochen, Germany). A microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with intra- or postoperative DS angiography in 90% of cases. The ICG technique missed mild but hemodynamically irrelevant stenosis that was evident on DS angiography in 7.3% of cases. The ICG technique missed angiographically relevant findings in three cases (one hemodynamically relevant stenosis and two residual aneurysm necks [2.7% of cases]). In two cases the missed findings were clinically and surgically inconsequential; in the third case, a 4-mm residual neck may require a second procedure. Indocyanine green videoangiography provided significant information for the surgeon in 9% of cases, most of which led to clip correction. Conclusions. Microscope-based ICG videoangiography is simple and provides real-time information about the patency of vessels of all sizes and about the aneurysm sac. This technique may be useful during routine aneurysm surgery as an independent form of angiography or as an adjunct to intra- or postoperative DS angiography.

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