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.

scholarly journals Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes

2015 ◽  
Vol 8 (9) ◽  
pp. 977-981 ◽  
Author(s):  
Kimon Bekelis ◽  
Dan Gottlieb ◽  
George Bovis ◽  
Yin Su ◽  
Stavropoula Tjoumakaris ◽  
...  
Keyword(s):  
Propensity Score ◽  
Cerebral Aneurysm ◽  
Readmission Rate ◽  
Cerebral Aneurysms ◽  
Postoperative Mortality ◽  
Fee For Service ◽  
Aneurysm Clipping ◽  
Unruptured Cerebral Aneurysm ◽  
Procedural Volume ◽  
Unruptured Cerebral Aneurysms

BackgroundIt is often questioned if one physician can conduct both open and endovascular techniques successfully and safely.ObjectiveTo investigate the association of combined open and endovascular expertise with the outcomes of unruptured cerebral aneurysm clipping.MethodsWe performed a cohort study of 100% of Medicare fee-for-service claims data for elderly patients who underwent surgical clipping for unruptured cerebral aneurysms between 2007 and 2012. To control for confounding we used propensity score conditioning, and controlled for clustering at the physician level.ResultsDuring the study, 3247 patients underwent clipping for unruptured cerebral aneurysms, and met the inclusion criteria. Of these, 766 (23.6%) underwent treatment by hybrid neurosurgeons, and 2481 (76.4%) by proceduralists, who performed only clipping. Multivariable regression analysis with propensity score adjustment demonstrated a lack of association of combined practice with 1-year postoperative mortality (OR=0.81; 95% CI 0.51 to 1.28), discharge to rehabilitation (OR=0.95; 95% CI 0.72 to 1.25), length of stay (adjusted difference 0.85 days; 95% CI −0.31 to 2.00), or 30-day readmission rate (OR=1.05; 95% CI 0.80 to 1.39). Higher procedural volume was independently associated with improved outcomes.ConclusionsIn a cohort of Medicare patients with unruptured aneurysms, we did not demonstrate a difference in mortality, discharge to rehabilitation, or readmission rate between hybrid neurosurgeons and surgeons performing only clipping.

scholarly journals Efficacy of Intraoperative Blood Salvage in Cerebral Aneurysm Surgery

2021 ◽  
Vol 10 (24) ◽  
pp. 5734
Author(s):  
Bedjan Behmanesh ◽  
Florian Gessler ◽  
Elisabeth Adam ◽  
Ulrich Strouhal ◽  
Sae-Yeon Won ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Blood Cell ◽  
Cerebral Aneurysm ◽  
Red Blood Cell ◽  
Cerebral Aneurysms ◽  
Cell Salvage ◽  
Aneurysm Surgery ◽  
Allogenic Blood ◽  
Intraoperative Cell Salvage ◽  
Unruptured Cerebral Aneurysm

Background. The use and effectiveness of intraoperative cell salvage has been analyzed in many surgical specialties. Until now, no data exist evaluating the efficacy of intraoperative cell salvage in cerebral aneurysm surgery. Aim. To evaluate the efficacy and cost effectiveness of intraoperative cell salvage in cerebral aneurysm surgery. Methods. Data were collected retrospectively for all the patients who underwent cerebral aneurysm surgery at our institution between 2013 and 2019. Routinely, we apply blood salvage through autotransfusion. The cases were divided into a ruptured cerebral aneurysm group and a unruptured cerebral aneurysm group. Results. A total of 241 patients underwent cerebral aneurysm clipping. Of all the cerebral aneurysms, 116 were ruptured and 125 were unruptured and clipped electively. Age, location of the aneurysm, postoperative red blood cell count, intraoperative blood loss, and number of allogenic blood cell transfusions were statistically significantly different between the groups. The autotransfusion of salvaged blood could only be facilitated in eight cases with ruptured cerebral aneurysms and in none with unruptured cerebral aneurysms clipped electively (p < 0.01). Additionally, 35 patients with ruptured cerebral aneurysms and one patient with unruptured cerebral aneurysm required allogenic red blood cell transfusion after surgery, and 71 vs. 2 units of blood were transfused (p < 0.0001). In terms of cost effectiveness, a total of EUR 45,189 in 241 patients was spent to run the autotransfusion system, while EUR 13,797 was spent for allogenic blood transfusion. Conclusions. The use of cell salvage in patients with unruptured cerebral aneurysm, undergoing elective surgery, is not effective.

scholarly journals Head-up display may facilitate safe keyhole surgery for cerebral aneurysm clipping

2018 ◽  
Vol 129 (4) ◽  
pp. 883-889 ◽  
Author(s):  
Terushige Toyooka ◽  
Naoki Otani ◽  
Kojiro Wada ◽  
Arata Tomiyama ◽  
Satoru Takeuchi ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Modern Technology ◽  
Field Of View ◽  
Minimum Size ◽  
Keyhole Surgery ◽  
Aneurysm Clipping ◽  
Unruptured Cerebral Aneurysm ◽  
Numeric Information ◽  
Dural Opening ◽  
3D Anatomy

OBJECTIVEThe head-up display (HUD) is a modern technology that projects images or numeric information directly into the observer’s sight line. Surgeons will no longer need to look away from the surgical view using the HUD system to confirm the preoperative or navigation image. The present study investigated the usefulness of the HUD system for performing cerebral aneurysm clipping surgeries.METHODSThirty-five patients underwent clipping surgery, including 20 keyhole surgeries for unruptured cerebral aneurysm, using the HUD system. Image information of structures such as the skull, cerebral vasculature, and aneurysm was integrated by the navigation software and linked with the positional coordinates of the microscope field of view. “Image injection” allowed visualization of the main structures that were concurrently tracked by the navigation image, and “closed shutter” switched the microscope field of view and the pointer image of the 3D brain image.RESULTSThe HUD system was effective for estimating the location and 3D anatomy of the aneurysm before craniotomy or dural opening in most patients. Scheduled keyhole minicraniotomy and opening of the sylvian fissure or partial rectal gyrus resection were performed on the optimized location with a minimum size in 20 patients.CONCLUSIONSThe HUD images superimposed on the microscope field of view were remarkably useful for less invasive and more safe aneurysm clipping and, in particular, keyhole clipping.

Blood flow disturbance in perforating arteries attributable to aneurysm surgery

2007 ◽  
Vol 107 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Tatsuya Sasaki ◽  
Namio Kodama ◽  
Masato Matsumoto ◽  
Kyouichi Suzuki ◽  
Yutaka Konno ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Infarction ◽  
Clinical Symptoms ◽  
Motor Evoked Potential ◽  
Parent Artery ◽  
Aneurysm Surgery ◽  
Flow Disturbance ◽  
Perforating Artery ◽  
Evoked Potential Monitoring ◽  
Perforating Arteries

Object The object of this study was to investigate patients with cerebral infarction in the area of the perforating arteries after aneurysm surgery. Methods The authors studied the incidence of cerebral infarction in 1043 patients using computed tomography or magnetic resonance imaging and the affected perforating arteries, clinical symptoms, prognosis, and operative maneuvers resulting in blood flow disturbance. Results Among 46 patients (4.4%) with infarction, the affected perforating arteries were the anterior choroidal artery (AChA) in nine patients, lenticulostriate artery (LSA) in nine patients, hypothalamic artery in two patients, posterior thalamoperforating artery in five patients, perforating artery of the vertebral artery (VA) in three patients, anterior thalamoperforating artery in nine patients, and recurrent artery of Heubner in nine patients. Sequelae persisted in 21 (45.7%) of the 46 patients; 13 (28.3%) had transient symptoms and 12 (26.1%) were asymptomatic. Sequelae developed in all patients with infarctions in perforating arteries in the area of the AChA, hypothalamic artery, or perforating artery of the VA; in four of five patients with posterior thalamoperforating artery involvement; and in two of nine with LSA involvement. The symptoms of anterior thalamoperforating artery infarction or recurrent artery of Heubner infarction were mild and/or transient. The operative maneuvers leading to blood flow disturbance in perforating arteries were aneurysmal neck clipping in 21 patients, temporary occlusion of the parent artery in nine patients, direct injury in seven patients, retraction in five patients, and trapping of the parent artery in four patients. Conclusions The patency of the perforating artery cannot be determined by intraoperative microscopic inspection. Intraoperative motor evoked potential monitoring contributed to the detection of blood flow disturbance in the territory of the AChA and LSA.

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.

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.

Assessment of Flow in Perforating Arteries During Intracranial Aneurysm Surgery Using Intraoperative Near-Infrared Indocyanine Green Videoangiography

2007 ◽  
Vol 61 (suppl_3) ◽  
pp. ONS-63-ONS-73 ◽  
Author(s):  
Jean G. de Oliveira ◽  
Jürgen Beck ◽  
Volker Seifert ◽  
Manoel J. Teixeira ◽  
Andreas Raabe
Keyword(s):  
Indocyanine Green ◽  
Visual Information ◽  
Intracranial Aneurysms ◽  
Near Infrared ◽  
Aneurysm Surgery ◽  
Indocyanine Green Videoangiography ◽  
Small Arteries ◽  
Perforating Artery ◽  
Clip Application ◽  
Perforating Arteries

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.

scholarly journals Verbal Memory Functions in Patients after the Ruptured and Unruptured Cerebral Aneurysm Surgery

2020 ◽  
Vol 57 (1) ◽  
pp. 81-92
Author(s):  
Ljiljana Pačić-Turk ◽  
Valerija Hauptfeld ◽  
Lana Maljković ◽  
Ivo Somek ◽  
Larissa Kalaus
Keyword(s):  
Cerebral Aneurysm ◽  
Verbal Memory ◽  
Verbal Learning ◽  
Cerebral Aneurysms ◽  
Anterior Communicating Artery ◽  
Aneurysm Surgery ◽  
Brain Aneurysm ◽  
Memory Functions ◽  
Unruptured Cerebral Aneurysm ◽  
Significant Difference

A cerebral aneurysm is a bulge in the wall of a brain blood vessel with a risk to rupture. It occurs in about 2% of the population, somewhat more often in women. Most aneurysms are located in the anterior circulation area. Aneurysm rupture is relatively rare and accounts for 5% of all cerebrovascular brain incidents. Ruptured and asymptomatic/unruptured aneurysms are often treated surgically at the Department of Neurosurgery, Medical School University of Zagreb. The study included 134 patients after cerebral aneurysm surgery during the last 10 years, and neuropsychological testing was performed on average 77 days after surgery. The average age was 52 years and they completed an average of 12 years of education. In the group of patients included in this study, 40.3% of them were operated after ruptured, and 59.7% for unruptured cerebral aneurysm. Most aneurysms were located in the middle cerebral and anterior communicating arteries. With regard to lateralization, there was an equal number of aneurysms located in the right and left hemisphere and bilaterally (on the anterior communicating artery). As part of regular neuropsychological assessment, tests of verbal learning and memory (numerical, logical and mechanical memory) were applied. The aims of the study were to find out whether patients operated for ruptured cerebral aneurysms show greater verbal memory impairments than patients operated for unruptured cerebral aneurysms and whether there was the significant effect of lateralization of aneurysm (to check the interaction effect of both rupture and lateralization on those functions). The results obtained show that, even though there are no statistically significant differences between groups of patients that underwent surgery for ruptured and unruptured brain aneurysm, patients show a trend of somewhat better results on most of the verbal memory functions after surgery for unruptured brain aneurysm. The results show statistically significant difference between groups of patients that underwent surgery for ACoA aneurysm and those with right lateralized cerebral aneurysms on most of the trails on AVLT test. Also, patients with operated ACoA aneurysm have significantly worse scores in learning process (AVLT 3 and AVLT 4) and especially on short-term and long-term verbal memory than the patients who were operated for left or right lateralized aneurysm.

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