Use of a Yaşargil Mirror as an Adjunct to Indocyanine Green Angiography to Evaluate the Patency of Elusive Posterior Communicating Arteries During Aneurysm Clipping

2012 ◽  
Vol 71 (suppl_1) ◽  
pp. onsE195-onsE197
Author(s):  
Jason Wilson ◽  
Ryan Screven ◽  
Jerome Volk ◽  
Troy Payner
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Internal Carotid ◽  
Clinical Presentation ◽  
Aneurysm Surgery ◽  
Aneurysm Clipping ◽  
Direct View ◽  
Vessel Patency ◽  
Surgical Field ◽  
Perforator Vessel

Abstract BACKGROUND AND IMPORTANCE: Indocyanine green angiography (ICGA) has become a useful intraoperative tool during aneurysm surgery to determine parent, branching, and perforator vessel patency. Although extremely useful, ICGA is limited to the evaluation of vessels that are in direct view in the surgical field. CLINICAL PRESENTATION: We present 2 cases of patients who underwent a craniotomy for clipping of unruptured posterior communicating artery aneurysms. A Yaşargil movable mirror was used as an adjuvant to ICGA to visualize the ventromedial posterior communicating vessels after clip placement to determine vessel patency. CONCLUSION: Although ICGA can be very useful during aneurysm surgery, it is limited to vessels directly visualized in the surgical field. A Yaşargil movable mirror can be used during ICGA to visualize elusive vessels, in these cases on the ventromedial surface of the internal carotid artery.

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.

scholarly journals Polypoidal Choroidal Vasculopathy in Congolese Patients

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Nelly N. Kabedi ◽  
David L. Kayembe ◽  
Gloria M. Elongo ◽  
Jean-Claude Mwanza
Keyword(s):  
Optical Coherence Tomography ◽  
Indocyanine Green ◽  
Polypoidal Choroidal Vasculopathy ◽  
Indocyanine Green Angiography ◽  
Clinical Presentation ◽  
Case Series ◽  
Systemic Hypertension ◽  
Optical Coherence ◽  
Blurred Vision ◽  
Choroidal Vasculopathy

Purpose. Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients. Methods. A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs. Results. Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively. Conclusions. PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.

Mirroring with Indocyanine Green Angiography in Aneurysm Surgery: Technical Note and Case Presentations

2019 ◽  
Vol 132 ◽  
pp. e696-e703
Author(s):  
Youngseop Lee ◽  
Myungsoo Kim ◽  
Jaechan Park ◽  
Byoung-Joon Kim ◽  
Wonsoo Son ◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Technical Note ◽  
Aneurysm Surgery ◽  
Case Presentations

Indocyanine Green Videoangiography in Aneurysm Surgery: Systematic Review and Meta-Analysis

Neurosurgery ◽  
2017 ◽  
Vol 83 (2) ◽  
pp. 166-180 ◽  
Author(s):  
Matteo Riva ◽  
Sepideh Amin-Hanjani ◽  
Carlo Giussani ◽  
Olivier De Witte ◽  
Michael Bruneau
Keyword(s):  
Systematic Review ◽  
Indocyanine Green ◽  
Primary Endpoint ◽  
Meta Analysis ◽  
Visual Observation ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Aneurysm Clipping ◽  
Vessel Stenosis ◽  
Pubmed Search

Abstract BACKGROUND Although digital subtraction angiography (DSA) may be considered the gold standard for intraoperative vascular imaging, many neurosurgical centers rely only on indocyanine green videoangiography (ICG-VA) for the evaluation of clipping accuracy. Many studies have compared the results of ICG-VA with those of intraoperative DSA; however, a systematic review summarizing these results is still lacking. OBJECTIVE To analyze the literature in order to evaluate ICG-VA accuracy in the identification of aneurysm remnants and vessel stenosis after aneurysm clipping. METHODS We performed a systematic literature review of ICG-VA accuracy during aneurysm clipping as compared to microscopic visual observation (primary endpoint 1) and DSA (primary endpoint 2). Quality of studies was assessed with the QUADAS-2 tool. Meta-analysis was performed using a random effects model. RESULTS The initial PubMed search resulted in 2871 records from January 2003 to April 2016; of these, 20 articles were eligible for primary endpoint 1 and 11 for primary endpoint 2. The rate of mis-clippings that eluded microscopic visual observation and were identified at ICG-VA was 6.1% (95% CI: 4.2-8.2), and the rate of mis-clippings that eluded ICG-VA and were identified at DSA was 4.5% (95% CI: 1.8-8.3). CONCLUSION Because a proportion of mis-clippings cannot be identified with ICG-VA, this technique should still be considered complementary rather than a replacement to DSA during aneurysm surgery. Incorporating other intraoperative tools, such as flowmetry or electrophysiological monitoring, can obviate the need for intraoperative DSA for the identification of vessel stenosis. Nevertheless, DSA likely remains the best tool for the detection of aneurysm remnants.

Endoscope-integrated indocyanine green video-angiography for cerebral aneurysm surgery: a more effective technique

2015 ◽  
Vol 3 (3-4) ◽  
Author(s):  
Ittichai Sakarunchai ◽  
Yoko Kato ◽  
Yasuhiro Yamada ◽  
Thomas Tommy
Keyword(s):  
Indocyanine Green ◽  
Cerebral Aneurysm ◽  
Conventional Technique ◽  
Parent Artery ◽  
Aneurysm Surgery ◽  
Small Vessels ◽  
Aneurysm Clipping ◽  
Unruptured Cerebral Aneurysm ◽  
Deep Area ◽  
Perforating Arteries

AbstractMicroscope-integrated indocyanine green video-angiography (mICG-VA) is used as an adjunct to aneurysm surgery in checking for small compromised perforating arteries and the remnant of an aneurysmal neck. A limitation of mICG-VA is the inability to access the deep area where small vessels are located behind the aneurysm sac or the parent artery. The endoscope-integrated ICG-VA (eICG-VA) is not only a tool in obtaining a wide angle of surgical view, but also is a technique to detect real-time blood flow during aneurysm clipping.Patients with an unruptured cerebral aneurysm who had conventional endoscope-assisted microsurgery and eICG-VA were enrolled. We compared the efficacy and additional details of imaging from both types of procedures.The data of seven patients were reviewed. In two cases of small perforating arteries that were hidden by the aneurysm sacs, more details were detected by eICG-VA. While the performance of the conventional technique was limited, the eICG-VA revealed a wide view in the deep area during aneurysm clipping.The eICG-VA provides more details of the aneurysm, especially in small perforating vessels that were hidden by the aneurysm. It can resolve the limitations of the conventional endoscope and mICG-VA.

Intraoperative Imaging Research for Paraclinoid Aneurysms Using the Indocyanine Green Angiography Technique

2019 ◽  
Vol 9 (2) ◽  
pp. 235-241
Author(s):  
Jiantaowang ◽  
Wen Si ◽  
Zhisheng Kan ◽  
Shuo Wang
Keyword(s):  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Near Infrared ◽  
Intraoperative Imaging ◽  
Artery Occlusion ◽  
Parent Artery ◽  
Aneurysm Clipping ◽  
Microsurgical Clipping ◽  
Perforating Artery ◽  
Paraclinoid Aneurysms

Background: Paraclinoid aneurysms are a challenging type of intracranial aneurysms due to their surrounding anatomy. Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Microscope-integrated near-infrared indocyanine green angiography (ICGA) is a new technique that allows for real-time evaluation of blood flow in the aneurysm and vessels. It is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature. Objective: To explore the intraoperative research of neuroimaging assessment of neck residuals and patency of branches for paraclinoid aneurysms using the indocyanine green angiography (ICGA) technique in the surgery. Methods: From January 2009 to December 2014, a retrospective study to evaluate the intraoperative value of ICGA in patients who underwent microsurgical clipping of paraclinoid aneurysms was performed. Intraoperative ICGA was performed using a fluorescence microscope before and after clipping. After the operation, three-dimensional CT angiography (CTA), digital substraction angiography (DSA) were used to evaluate the use of intraoperative ICGA. The presence and patency of the parent artery and perforating artery around the aneurysm, and the information of aneurysm were analyzed in the surgical field through intraoperative imaging. These findings of ICGA were compared with those of postoperative DSA or CTA. Results: The study included 69 cases of adults and three out of them were noted as having significantly changed information provided by intraoperative ICGA. After initial clip placement, neck remnants of the aneurysm were found in 1 patient, inadvertent clipping of branching vessels in 2 patients, and inadvertent clipping of perforating vessels in two patients. After adjusting the aneurysm clipping, no such unexpected findings as parent or branching artery occlusion, or aneurysm sac omission were found on postoperative angiograms. The postoperative DSA and CTA results were consistent with the intraoperative ICGA findings. Conclusions: Microscope-integrated ICGA is useful in the clipping of paraclinoid aneurysms to monitor residual aneurysm, parent artery stenosis or perforating artery occlusion during paraclinoid aneurysm clipping. A combination of ICGA and microsurgical techniques may ultimately prove to be the most effective strategy for maximizing the safety and efficacy of aneurysm surgery.

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