Intraoperative Near-infrared Indocyanine Green Videoangiography Performed with a Surgical Microscope - Applications in Cerebrovascular Surgery

2008 ◽  
Vol 3 (1) ◽  
pp. 66 ◽  
Author(s):  
Yasushi Takagi ◽  
Keiko Sawamura ◽  
Nobuo Hashimoto ◽  
Nobuo Hashimoto ◽  
◽  
...  
Keyword(s):  
Indocyanine Green ◽  
Near Infrared ◽  
Indocyanine Green Videoangiography ◽  
Surgical Microscope ◽  
Cerebrovascular Surgery

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.

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

2005 ◽  
Vol 103 (6) ◽  
pp. 982-989 ◽  
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.

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.

scholarly journals Quantitative Analysis of Near-Infrared Indocyanine Green Videoangiography for Predicting Functional Outcomes After Spinal Intramedullary Ependymoma Resection

2019 ◽  
Vol 17 (5) ◽  
pp. 531-539 ◽  
Author(s):  
Hironori Arima ◽  
Kentaro Naito ◽  
Toru Yamagata ◽  
Shinichi Kawahara ◽  
Kenji Ohata ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Quantitative Analysis ◽  
Indocyanine Green ◽  
Functional Outcomes ◽  
Near Infrared ◽  
Peak Time ◽  
Functional Grade ◽  
Indocyanine Green Videoangiography ◽  
Peak Intensity ◽  
Ventral Spinal Cord

Abstract BACKGROUND One of the most critical steps in surgery for spinal intramedullary ependymomas is the resection of small feeding arteries from the anterior spinal artery with anatomical preservation of the normal circulation of the ventral spinal cord. OBJECTIVE To quantitatively analyze the microcirculation of the ventral spinal cord by near-infrared indocyanine green videoangiography (ICG-VA) after the spinal intramedullary ependymoma resection. METHODS This retrospective study included 12 patients (7 male and 5 female; average age 55.2 years, range 36-79 years). Patients’ neurological conditions were assessed based on the modified McCormick functional schema of grade 1 (neurologically normal) to 5 (severe deficit). Postoperative functional assessment was conducted at least 3 months after surgery. Quantitative analysis of vascular flow dynamics was carried out following spinal intramedullary ependymoma resection. Fluorescence intensities were measured and the indocyanine green (ICG) intensity-time curves were analyzed and compared with the functional outcomes after surgery. RESULTS Microscopically total or subtotal resection of the intramedullary ependymoma was achieved in all cases. Average peak time on ICG-VA was significantly shorter in the postoperative functional grade 1 to 2 group than in the postoperative functional grade 3 to 5 group, but there was no significant difference in average peak intensity between the 2 groups. Postoperative functional grade and the peak time of ICG, but not peak intensity, appeared correlated. CONCLUSION To the best of our knowledge, this is the first report showing that quantitative analysis of ICG-VA may predict functional outcomes after spinal intramedullary ependymoma resection.

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