Safety and completeness of using indocyanine green videoangiography combined with digital subtraction angiography for aneurysm surgery in a hybrid operating theater

2019 ◽  
Vol 43 (4) ◽  
pp. 1163-1171
Author(s):  
Jong-Hwa Park ◽  
Jong Young Lee ◽  
Hong Jun Jeon ◽  
Byung Chul Lim ◽  
Seoung Woo Park ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Operating Theater ◽  
Indocyanine Green Videoangiography

scholarly journals Endoscope- versus microscope-integrated near-infrared indocyanine green videoangiography in aneurysm surgery

2019 ◽  
Vol 131 (5) ◽  
pp. 1413-1422 ◽  
Author(s):  
Gerrit Fischer ◽  
Jana Rediker ◽  
Joachim Oertel
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Digital Subtraction ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
Aneurysm Occlusion ◽  
Perforating Arteries

OBJECTIVEThe quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving blood flow in the parent, branching, and perforating arteries. For a few years, there has been a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: microscope-integrated indocyanine green videoangiography (mICG-VA). This method allows for real-time information about blood flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field, especially through small craniotomies. To compensate for these drawbacks, an endoscope-integrated ICG-VA (eICG-VA) was developed. The objective of the present study was to assess the use of eICG-VA in comparison with mICG-VA for intraoperative blood flow evaluation.METHODSIn the period between January 2011 and January 2015, 216 patients with a total of 248 intracranial saccular aneurysms were surgically treated in the Department of Neurosurgery of Saarland University Medical Center in Homburg/Saar, Germany. During 95 surgeries in 88 patients with a total of 108 aneurysms, intraoperative evaluation was performed with both eICG-VA and mICG-VA. After clipping, evaluation of complete aneurysm occlusion and flow in the parent, branching, and perforating arteries was performed using both methods. Intraoperative applicability of each technique was compared with the other and with postoperative digital subtraction angiography as a standard evaluation technique.RESULTSEvaluation of completeness of aneurysm occlusion and of flow in the parent, branching, and perforating arteries was more successful with eICG-VA than with mICG-VA, especially for aneurysm neck assessment (88.9% vs 69.4%). For 63.9% of the aneurysms (n = 69), both methods were equivalent, but in 30.6% of the cases (n = 33), the eICG-VA provided better results for evaluating the post-clipping situation. In 4.6% of these aneurysms (n = 5), the information given by the additional endoscope considerably changed the surgical procedure. Thus, one residual aneurysm (0.9%), two neck remnants (1.9%), and two branch occlusions (1.9%) could be prevented. Nevertheless, two incomplete aneurysm occlusions (1.9%) and six neck remnants (5.6%) were revealed by postoperative digital subtraction angiography.CONCLUSIONSEndoscope-integrated ICG-VA seems to be an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers higher illumination, magnification, and an extended viewing angle. Its main advantage is its ability to assess deep-seated aneurysms, especially through small craniotomies, but further studies are required.

scholarly journals Comparison of Efficacy of Intraoperative Indocyanine Green Videoangiography in Clipping of Anterior Circulation Aneurysms with Postoperative Digital Subtraction Angiography

2017 ◽  
Vol 08 (03) ◽  
pp. 342-345 ◽  
Author(s):  
Vikas Kumar ◽  
Anita Jagetia ◽  
Daljit Singh ◽  
Arvind Kumar Srivastava ◽  
Monica Sehgal Tandon
Keyword(s):  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Cerebral Aneurysms ◽  
Postoperative Outcome ◽  
Cost Effective ◽  
Digital Subtraction ◽  
Anterior Circulation ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Neck ◽  
Anterior Circulation Aneurysms

ABSTRACT Introduction: The aim of this study is to assess the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) using postoperative digital subtraction angiography (DSA) in clipped anterior circulation aneurysms. Materials and Methods: A prospective study was conducted for 1 year which included thirty patients of anterior circulation aneurysm treated by clipping of aneurysm. Intraoperative ICG-VA was performed on all the patients. Postoperative DSA was performed to assess the efficacy of ICG-VA. Results: Intraoperative ICG-VA revealed the occlusion of aneurysm in all the thirty patients. Postoperative DSA revealed aneurysm neck remnant in two patients and demonstrated no branch occlusion. Conclusions: Intraoperative ICG-VA is useful in assessing the completeness of clipping of cerebral aneurysms and ensures patency of branch vessels, thus providing a better postoperative outcome. It replaces the need for invasive postoperative angiographic imaging in a selected group of patients and is also cost effective.

Evaluation of Serial Intraoperative Surgical Microscope-Integrated Intraoperative Near-Infrared Indocyanine Green Videoangiography in Patients With Cerebral Arteriovenous Malformations

2011 ◽  
Vol 70 (suppl_1) ◽  
pp. ons34-ons43 ◽  
Author(s):  
Yasushi Takagi ◽  
Keiko Sawamura ◽  
Nobuo Hashimoto ◽  
Susumu Miyamoto
Keyword(s):  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Arteriovenous Malformations ◽  
Near Infrared ◽  
Fluorescence Angiography ◽  
Digital Subtraction ◽  
Cerebral Arteriovenous Malformations ◽  
Viable Option ◽  
Indocyanine Green Videoangiography ◽  
Surgical Microscope

Abstract BACKGROUND: With the use of indocyanine green (ICG) as a novel fluorescent dye, fluorescence angiography has recently reemerged as a viable option. OBJECTIVE: To show the result of ICG videoangiography in cases of cerebral arteriovenous malformations. METHODS: Twenty-seven ICG videoangiography procedures were performed in 11 patients with cerebral arteriovenous malformations. Intraoperative digital subtraction angiography (DSA) was performed 27 times in these patients. The timing of intraoperative DSA was before dissection, after clipping of feeders, and after dissection of the nidus. RESULTS: The procedures were performed in 4.7 ± 1.4 minutes (mean ± SD; n = 27 minutes), whereas intraoperative digital subtraction angiography was performed for a mean of 16.6 ± 3.8 minutes (n = 27 minutes). In predissection studies, feeders were visualized by ICG in 3 of 9 cases. The nidus was visualized in all 9 cases, and drainers were visualized in 8. Intraoperative DSA visualized the feeders, nidus, and drainers in all 9 cases. After clipping of feeders, ICG videoangiography showed flow reduction of the nidus in 7 of 7 cases. Intraoperative DSA also showed that finding in 9 of 9 cases. After total dissection of the nidus, all cases disclosed that the drainers were without ICG filling. Intraoperative DSA also showed that result in all of the cases. Unexpected residual nidus was not visualized in our series with either method. CONCLUSION: We found that ICG videoangiography is helpful for resecting cerebral arteriovenous malformation. It is especially effective in visualizing the nidus and superficial drainers, as well as changes in flow after clipping or coagulating of feeders.

Intraoperative Indocyanine Green Videoangiography for Spinal Vascular Lesions: Case Report

2011 ◽  
Vol 68 (suppl_1) ◽  
pp. onsE241-onsE245 ◽  
Author(s):  
Tomohiro Murakami ◽  
Izumi Koyanagi ◽  
Takahisa Kaneko ◽  
Satoshi Iihoshi ◽  
Kiyohiro Houkin
Keyword(s):  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Digital Subtraction Angiography ◽  
Near Infrared ◽  
Vascular Lesions ◽  
Vascular Tumors ◽  
Digital Subtraction ◽  
Indocyanine Green Videoangiography ◽  
Surgical Microscope ◽  
Spinal Arteriovenous Fistula

Abstract BACKGROUND AND IMPORTANCE: In surgery of spinal vascular lesions such as spinal arteriovenous fistula or vascular tumors, assessment of feeding arteries and draining veins is important. Intraoperative digital subtraction angiography is useful but is invasive and sometimes technically demanding. Near-infrared indocyanine green (ICG) videoangiography is less invasive and has been reported as an intraoperative diagnosis of arterial patency during clipping surgery of cerebral aneurysms or bypass surgeries. We present our experience with intraoperative ICG videoangiography in 3 cases of spinal vascular lesions. CLINICAL PRESENTATION: Two patients had spinal arteriovenous fistula (perimedullary, n = 1; dural, n = 1), and 1 patient had spinal cord hemangioblastoma at the thoracic or thoracolumbar level. The surgical microscope was an OPMI Pentero (Carl Zeiss, Oberkochen, Germany). After laminectomy and opening of the dura, ICG (5 mg) was injected intravenously. The ICG angiography clearly demonstrated feeding and draining vessels. The ICG findings greatly helped successful interruption of arteriovenous fistula and total removal of the tumor. CONCLUSION: Intraoperative ICG videoangiography for spinal vascular lesions was useful by providing information on vascular dynamics directly. However, the diagnostic area is limited to the field of the surgical microscope. Although intraoperative digital subtraction angiography is still needed in cases of complex spinal vascular lesions, ICG videoangiography will be an important diagnostic modality in the field of spinal vascular surgeries.

Use of Microscope-Integrated Near-Infrared Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arteriovenous Fistulae

Neurosurgery ◽  
2010 ◽  
Vol 66 (5) ◽  
pp. 978-985 ◽  
Author(s):  
Ricardo A. Hanel ◽  
Peter Nakaji ◽  
Robert F. Spetzler
Keyword(s):  
Surgical Treatment ◽  
Indocyanine Green ◽  
Digital Subtraction Angiography ◽  
Near Infrared ◽  
Type I ◽  
Spinal Angiography ◽  
Digital Subtraction ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulae ◽  
Excitation Light

Abstract OBJECTIVE Identification and complete interruption of fistulae are essential but not always obvious during the surgical treatment of spinal dural arteriovenous fistulae (dAVFs). We examined cases in which we identified and confirmed surgical obliteration of a spinal dAVF with the aid of microscope-integrated near-infrared indocyanine green (ICG) videoangiography. METHODS ICG videoangiography was performed during 6 surgical interventions in which 6 intradural dorsal AVFs (type I) were interrupted. An operating microscope-integrated light source containing infrared excitation light illuminated the operating field and was used to visualize an intravenous bolus of ICG. The locations of fistulae, feeding arteries, and draining veins and documentation of occlusion of the fistulae were compared with findings on preoperative and postoperative digital subtraction angiography. RESULTS ICG videoangiography identified the fistulous point(s), feeding arteries, and draining veins in all 6 cases, as confirmed by immediate postoperative selective spinal angiography. In 1 case, intraoperative ICG ruled out an additional questionable fistula at a contiguous level suspected on the preoperative angiography. CONCLUSION Microscope-based ICG videoangiography is simple and provides real-time information about the precise location of spinal dAVFs. During spinal dAVF surgery, this technique can be useful as an independent form of angiography or as an adjunct to intra or postoperative digital subtraction angiography. Larger series are needed to determine whether use of this modality could reduce the need for immediate postoperative spinal angiography after obliteration of intradural dorsal AVFs.

The “Squeezing Maneuver” in Microsurgical Clipping of Intracranial Aneurysms Assisted by Indocyanine Green Videoangiography

2014 ◽  
Vol 10 (2) ◽  
pp. 208-213 ◽  
Author(s):  
Alessandro Della Puppa ◽  
Oriela Rustemi ◽  
Marta Rossetto ◽  
Giorgio Gioffrè ◽  
Marina Munari ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Intracranial Aneurysms ◽  
Aneurysm Surgery ◽  
Radiological Findings ◽  
Indocyanine Green Videoangiography ◽  
Microsurgical Clipping ◽  
Intraoperative Detection ◽  
Small Series ◽  
Vessel Patency ◽  
Derived Data

Abstract BACKGROUND: Indocyanine green videoangiography (ICGV) is becoming routine in intracranial aneurysm surgery to assess intraoperatively both sac obliteration and vessel patency after clipping. However, ICGV-derived data have been reported to be misleading at times. We recently noted that a simple intraoperative maneuver, the “squeezing maneuver,” allows the detection of deceptive ICGV data on aneurysm exclusion and allows potential clip repositioning. The squeezing maneuver is based on a gentle pinch of the dome of a clipped aneurysm when ICGV documents its apparent exclusion. OBJECTIVE: To present the surgical findings and the clinical outcome of this squeezing maneuver. METHODS: Data from 23 consecutive patients affected by intracranial aneurysms who underwent the squeezing maneuver were analyzed retrospectively. The clip was repositioned in all cases when the dyeing of the sac was visualized after the maneuver. RESULTS: In 22% of patients, after an initial ICGV showing the aneurysm exclusion after clipping, the squeezing maneuver caused the prompt dyeing of the sac; in all cases, the clip was consequently repositioned. A calcification/atheroma of the wall/neck was predictive of a positive maneuver (P = .001). The aneurysm exclusion rate at postoperative radiological findings was 100%. CONCLUSION: With the limits of our small series, the squeezing maneuver appears helpful in the intraoperative detection of misleading ICGV data, mostly when dealing with aneurysms with atheromatic and calcified walls.

Indocyanine Green Videoangiography “In Negative”: Definition and Usefulness in Intracranial Dural Arteriovenous Fistulae

2013 ◽  
Vol 73 (suppl_1) ◽  
pp. ons86-ons92 ◽  
Author(s):  
Juan Antonio Julián ◽  
Pablo Miranda Lloret ◽  
Fernando Aparici Robles ◽  
Andrés Beltrán Giner ◽  
Carlos Botella Asunción
Keyword(s):  
Indocyanine Green ◽  
Arteriovenous Fistula ◽  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Simple Procedure ◽  
Vascular Pathology ◽  
Digital Subtraction ◽  
Indocyanine Green Videoangiography ◽  
Arteriovenous Fistulae ◽  
Intracranial Dural Arteriovenous Fistulae

Abstract BACKGROUND: Indocyanine green videoangiography (IGV) raises important limitations when we use it in vascular pathology, especially in cases with arterialization of the venous system such as arteriovenous malformations and fistulae. OBJECTIVE: Our objective was to provide a simple procedure that overcomes the limitations of conventional IGV. We define IGV in negative (IGV-IN), so-called because, in its first phase, the vessel to analyze is clipped, and we report 3 cases of intracranial dural arteriovenous fistulae treated with this procedure. METHODS: In 2011, we applied IGV-IN to 3 patients at our center with Borden type III intracranial arteriovenous fistulae. RESULTS: In all 3 cases, IGV-IN enabled both diagnosis and post-dural arteriovenous fistula exclusion control in 1 integrated procedure no longer than 1 minute, requiring only 1 visualization. CONCLUSION: IGV-IN is an improvement over the conventional IGV method and is able to provide more information in a shorter period of time. It is an intuitive and highly visual procedure, and, more importantly, it is reversible. Studies with larger samples are necessary to determine whether IGV-IN can further reduce the need for postoperative digital subtraction angiography.

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