Intraoperative evaluation of blood flow with indocyanine green videoangiography

2015 ◽  
pp. 74-85
Author(s):  
Francesco Acerbi ◽  
Morgan Broggi ◽  
Marco Schiariti ◽  
Giovanni Broggi ◽  
Paolo Ferroli
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Indocyanine Green Videoangiography ◽  
Intraoperative Evaluation

scholarly journals Blood Flow Assessment of Arteriovenous Malformations Using Intraoperative Indocyanine Green Videoangiography

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Naoki Kato ◽  
Vincent Prinz ◽  
Julius Dengler ◽  
Peter Vajkoczy
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Indocyanine Green ◽  
Region Of Interest ◽  
Flow Dynamics ◽  
Flow Index ◽  
Indocyanine Green Videoangiography ◽  
Blood Flow Index ◽  
High Resolution Images ◽  
The Individual

Intraoperative indocyanine green (ICG) videoangiography is widely used in patients undergoing neurosurgery. FLOW800 is a recently developed analytical tool for ICG videoangiography to assess semi-quantitative flow dynamics; however, its efficacy is unknown. In this study, we evaluated its functionality in the assessment of flow dynamics of arteriovenous malformation (AVM) through ICG videoangiography under clinical settings. ICG videoangiography was performed in the exposed AVM in eight patients undergoing surgery. FLOW800 analysis was applied directly, and gray-scale and color-coded maps of the surgical field were obtained. After surgery, a region of interest was placed on the individual vessels to obtain time-intensity curves. Parameters of flow dynamics, including the maximum intensity, transit time, and cerebral blood flow index, were calculated using the curves. The color-coded maps provided high-resolution images; however, reconstruction of colored images was restricted by the depth, approach angle, and brain swelling. Semi-quantitative parameters were similar among the feeders, niduses, and drainers. However, a higher cerebral blood flow index was observed in the feeders of large AVM (>3 cm) than in those of small AVM (P < 0.05). Similarly, the cerebral blood flow index values were positively correlated with the nidus volume (P < 0.01). FLOW800 enabled visualization of the AVM structure and safer resection, except in case of deep-seated AVM. Moreover, semi-quantitative values in the individual vessels through using ICG intensity diagram showed different patterns according to size of the AVM. ICG videoangiography showed good performance in evaluating flow dynamics of the AVM in patients undergoing surgery.

Real-Time Overlapping of Indocyanine Green—Video Angiography With White Light Imaging for Vascular Neurosurgery: Technique, Implementation, and Clinical Experience

2020 ◽  
Vol 19 (4) ◽  
pp. 453-460 ◽  
Author(s):  
Dimitrios Athanasopoulos ◽  
Axel Heimann ◽  
Makoto Nakamura ◽  
Irini Kakaletri ◽  
Oliver Kempski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Real Time ◽  
White Light ◽  
Multispectral Imaging ◽  
Tissue Perfusion ◽  
Indocyanine Green Videoangiography ◽  
Black And White ◽  
Surgical Clip ◽  
Vascular Neurosurgery

Abstract BACKGROUND Fluorescent-guided techniques in vascular neurosurgery can be demonstrated via black and white indocyanine green videoangiography (ICG-VA). Multispectral imaging (MFL) is a new method, which overlaps fluorescence with the white light and provides a fluorescent white light augmented reality image to the surgeon. OBJECTIVE To investigate (a) whether MFL can enhance the visualization of the blood-flow with simultaneous visualization of the anatomic structures and (b) if MFL can ergonomically improve the microvascular surgical treatment compared to ICG-VA. METHODS A digital imaging of the blood flow after intravenous injection of ICG on 7 pigs was performed in real time under white light, standard fluorescence, and MFL. The blood flow was interrupted with a surgical clip, demonstrating the blockage of the blood flow. We prospectively included 30 patients with vascular deformities. The vasculature was visualized on the microscope's monitor and through the microscope's eyepiece. RESULTS In the animal experiment, the visualization of the anatomy and the blood flow under MFL produced high resolution images. The occlusion of blood vessels demonstrated sufficiently the blockage of tissue perfusion and its reperfusion after clip removal. During all 30 surgical cases, the MFL technique and the direct delivery of the pseudo-colored image through the eyepiece allowed for enhanced anatomic and dynamic data. CONCLUSION MFL was shown to be superior to the classic ICG-VA, delivering enhanced data and notably improving the workflow due to the simultaneous and precise white light visualization of the blood flow and the surrounding anatomic structures.

scholarly journals Idiopathic dissecting cerebral aneurysm of the distal anterior cerebral artery in an infant successfully treated with aneurysmectomy: illustrative case

2021 ◽  
Vol 1 (9) ◽  
Author(s):  
Suguru Nagamitsu ◽  
Natsue Kaneko ◽  
Toshikazu Nagatsuna ◽  
Hiroaki Yasuda ◽  
Manabu Urakawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Cerebral Artery ◽  
Peripheral Blood ◽  
Anterior Cerebral Artery ◽  
Pathological Examination ◽  
Peripheral Blood Flow ◽  
Indocyanine Green Videoangiography ◽  
Imaging Results ◽  
Distal Anterior Cerebral Artery

BACKGROUNDIdiopathic dissecting cerebral aneurysms (IDCAs) are male dominant but are extremely rare in children. Many IDCAs in children are located in the posterior cerebral artery and the supraclinoid internal cervical artery. No cases of IDCA of the distal anterior cerebral artery (ACA) have been reported.OBSERVATIONSA previously healthy 7-month-old boy experienced afebrile seizures and presented at the authors’ hospital 1 week after the first seizure. He was not feeling well but had no neurological deficits. The authors diagnosed a ruptured aneurysm of the right distal ACA based on imaging results. He underwent emergency craniotomy to prevent re-rupture of the aneurysm. Using intraoperative indocyanine green videoangiography, the authors confirmed peripheral blood flow and then performed aneurysmectomy. Pathological examination of the aneurysm revealed a thickened intima, fragmentation of the internal elastic lamina, and a hematoma in the aneurysmal wall. The authors ultimately diagnosed IDCA because no cause was indicated, including a history of trauma. The boy recovered after surgery and was subsequently discharged with no complications.LESSONSThe authors reported, for the first time, IDCA of the distal ACA in an infant. The trapping technique is often used for giant fusiform aneurysms in infants. Indocyanine green videoangiography is useful for evaluating peripheral blood flow during trapping in this case.

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 Integration of Indocyanine Green Videoangiography With Operative Microscope: Augmented Reality for Interactive Assessment of Vascular Structures and Blood Flow

2015 ◽  
Vol 11 (2) ◽  
pp. 252-258 ◽  
Author(s):  
Nikolay L Martirosyan ◽  
Jesse Skoch ◽  
Jeffrey R Watson ◽  
G Michael Lemole ◽  
Marek Romanowski ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Real Time ◽  
Femoral Artery ◽  
White Light ◽  
Near Infrared ◽  
Field Of View ◽  
Fluorescence Angiography ◽  
Indocyanine Green Videoangiography ◽  
Operative Microscope

Abstract BACKGROUND Preservation of adequate blood flow and exclusion of flow from lesions are key concepts of vascular neurosurgery. Indocyanine green (ICG) fluorescence videoangiography is now widely used for the intraoperative assessment of vessel patency. OBJECTIVE Here, we present a proof-of-concept investigation of fluorescence angiography with augmented microscopy enhancement: real-time overlay of fluorescence videoangiography within the white light field of view of conventional operative microscopy. METHODS The femoral artery was exposed in 7 anesthetized rats. The dissection microscope was augmented to integrate real-time electronically processed near-infrared filtered images with conventional white light images seen through the standard oculars. This was accomplished by using an integrated organic light-emitting diode display to yield superimposition of white light and processed near-infrared images. ICG solution was injected into the jugular vein, and fluorescent femoral artery flow was observed. RESULTS Fluorescence angiography with augmented microscopy enhancement was able to detect ICG fluorescence in a small artery of interest. Fluorescence appeared as a bright-green signal in the ocular overlaid with the anatomic image and limited to the anatomic borders of the femoral artery and its branches. Surrounding anatomic structures were clearly visualized. Observation of ICG within the vessel lumens permitted visualization of the blood flow. Recorded video loops could be reviewed in an offline mode for more detailed assessment of the vasculature. CONCLUSION The overlay of fluorescence videoangiography within the field of view of the white light operative microscope allows real-time assessment of the blood flow within vessels during simultaneous surgical manipulation. This technique could improve intraoperative decision making during complex neurovascular procedures.

Usefulness of Tumor Blood Flow Imaging by Intraoperative Indocyanine Green Videoangiography in Hemangioblastoma Surgery

2014 ◽  
Vol 82 (3-4) ◽  
pp. e495-e501 ◽  
Author(s):  
Masato Hojo ◽  
Yoshiki Arakawa ◽  
Takeshi Funaki ◽  
Kazumichi Yoshida ◽  
Takayuki Kikuchi ◽  
...  
Keyword(s):  
Blood Flow ◽  
Indocyanine Green ◽  
Flow Imaging ◽  
Tumor Blood Flow ◽  
Indocyanine Green Videoangiography ◽  
Blood Flow Imaging

scholarly journals Utility of Indocyanine Green Videoangiography with FLOW 800 Analysis in Brain Tumor Resection - Venous Protection Technique

2021 ◽  
Author(s):  
Yue Sun ◽  
Zilan Wang ◽  
Fan Jiang ◽  
Xingyu Yang ◽  
Tan Xin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Brain Tumor ◽  
Indocyanine Green ◽  
Tumor Resection ◽  
Cerebral Veins ◽  
Central Nervous System Tumor ◽  
Indocyanine Green Videoangiography ◽  
Flow Monitoring ◽  
Brain Tumor Resection ◽  
Flow 800

Abstract Background: When it comes to central nervous system tumor resection, preserving vital venous structures to avoid devastating consequences such as brain edema and hemorrhage is important. Wheras, in clinical practice, it is difficult to obtain clear and vivid intraoperative venous visualization and blood flow analysis.Methods: We presented our clinical cases to demonstrate the process of venous preservation during surgical resection through the application of indocyanine green videoangiography (ICG-VA) integrated with FLOW 800. Galen vein, sylvian vein and superior cerebral veins of the brain were included.Results: Clear documentations of the veins from different venous groups were obtained via ICG-VA integrated with FLOW 800, which semiquantitatively analyzed the flow dynamics. ICG-VA integrated with FLOW 800 enabled us to achieve brain tumor resection without venous injury and obstructing the venous flux.Conclusions: ICG-VA integrated with FLOW 800 is an efficient method for venous preservation, though further comparison between ICG-VA integrated with FLOW 800 and other techniques of intraoperative blood flow monitoring is needed.

Sign in / Sign up

Export Citation Format

Share Document