Acta Neurochirurgica

, Volume 157, Issue 8, pp 1295–1301 | Cite as

Development of a new high-resolution intraoperative imaging system (dual-image videoangiography, DIVA) to simultaneously visualize light and near-infrared fluorescence images of indocyanine green angiography

  • Taku SatoEmail author
  • Kyouichi Suzuki
  • Jun Sakuma
  • Noboru Takatsu
  • Yasushi Kojima
  • Tetsuo Sugano
  • Kiyoshi Saito
Clinical Article - Vascular



Intraoperative indocyanine green videoangiography (ICG-VA) has been widely used in vascular surgery, where vessels are clearly shown as white on a black background. However, other structures cannot be observed during ICG-VA. We have developed a new, high-resolution intraoperative imaging system (dual-image VA [DIVA]) to simultaneously visualize both light and near-infrared (NIR) fluorescence images from ICG-VA, allowing observation of other structures.


The operative field was illuminated via an operating microscope by halogen and xenon lamps with a filter to eliminate wavelengths over 780 nm. In the camera unit, visible light was filtered to 400–700 nm and NIR fluorescence emission light was filtered to 800–900 nm using a special sensor unit with an optical filter. Light and NIR fluorescence images were simultaneously visualized on a single monitor.


Our system clearly visualized the operative field together with fluorescence-enhanced blood flow. In aneurysm surgeries, we could confirm incomplete clipping with the neck remnant or with remnant flow into the aneurysm. In cases of arteriovenous malformation or arteriovenous fistula, feeding arteries and draining veins were easily distinguished.


This system allows observation of the operative field and enhanced blood flow by ICG together in real time and may facilitate various types of neurovascular surgery.


Dual-image videoangiography High-resolution microscopic imaging Indocyanine green Near-infrared fluorescence 



This study was supported by grants for the Development of Medical & Welfare Devices in Fukushima Prefecture (24-829).

Conflict of interest

Takatsu and Kojima are employees of Mizuho Corporation. Sugano is an employee of Mitsubishi Electric Engineering Co., Ltd. They have competing financial interests. All remaining authors have declared no conflicts of interest.

Informed consent

Informed consent was obtained from all patients or their legal representatives before enrollment in the study.

Supplementary material


We developed a new high-resolution intraoperative imaging system to simultaneously visualize both the light and near-infrared fluorescence images of indocyanine green angiography. It clearly shows surrounding brain structures and blood flow in the middle cerebral arteries and the aneurysm. After clipping, indocyanine green angiography was performed again. It vividly reveals the anatomical relation of the obliterated aneurysm, clips, preserved blood flow in the middle cerebral arteries, and surrounding brain. Standard indocyanine green angiography shows near-infrared fluorescence image of vessels. It’s hard to realize the anatomical relation of surrounding structures. (MOV 31616 kb)


  1. 1.
    Akdemir H, Oktem IS, Tucer B, Menkü A, Başaslan K, Günaldi O (2006) Intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invasive Neurosurg 49:312–316CrossRefPubMedGoogle Scholar
  2. 2.
    Anegawa S, Hayashi T, Torigoe R, Harada K, Kihara S (1994) Intraoperative angiography in the resection of arteriovenous malformations. J Neurosurg 80:73–78CrossRefPubMedGoogle Scholar
  3. 3.
    Dashti R, Laakso A, Niemela M, Porras M, Hernesniemi J (2009) Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 71:543–550CrossRefPubMedGoogle Scholar
  4. 4.
    de Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A (2008) Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 61(3 suppl):1300–1310Google Scholar
  5. 5.
    Handa T, Katare RG, Nishimori H, Wariishi S, Fukutomi T, Yamamoto M, Sasaquri S, Sato T (2010) New device for intraoperative graft assessment: HyperEye charge-coupled device camera system. Gen Thorac Cardiovasc Surg 58:68–77CrossRefPubMedGoogle Scholar
  6. 6.
    Ichikawa T, Suzuki K, Watanabe Y (2014) Intra-arterial fluorescence angiography with injection of fluorescein sodium from the superficial temporal artery during aneurysm surgery: technical notes. Neurol Med Chir (Tokyo) 54:490–496CrossRefGoogle Scholar
  7. 7.
    Killory BD, Nakaji P, Gonzales LF, Ponce FA, Wait SD, Spetzler RF (2009) Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green angiography during cerebral arteriovenous malformation surgery. Neurosurgery 65:456–462CrossRefPubMedGoogle Scholar
  8. 8.
    Kinouchi H, Yanagisawa T, Suzuki A, Ohta T, Hirano Y, Sugawara T, Sasajima T, Mizoi K (2004) Simultaneous microscopic and endoscopic monitoring during surgery for internal carotid artery aneurysms. J Neurosurg 101:989–995CrossRefPubMedGoogle Scholar
  9. 9.
    Klopfenstein JD, Spetzler RF, Kim LJ, Feiz-Erfan I, Han PP, Zabramski JM, Porter RW, Albuquerque FC, McDougall CG, Florella DJ (2004) Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:230–235CrossRefPubMedGoogle Scholar
  10. 10.
    Kono K, Uka A, Mori M, Haga S, Hamada Y, Nagata S (2013) Intra-arterial injection of indocyanine green in cerebral arteriovenous malformation surgery. Turk Neurosurg 23:676–679PubMedGoogle Scholar
  11. 11.
    Kuroda K, Kinouchi H, Kanemaru K, Nishiyama Y, Ogiwara M, Yoshioka H, Horikoshi T (2013) Intra-arterial injection fluorescein videoangiography in aneurysm surgery. Neurosurgery 72(2 Suppl Operative):141–150Google Scholar
  12. 12.
    Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V (2003) Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:132–139PubMedGoogle Scholar
  13. 13.
    Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FPK, Kamerman JD, Seifert V, Spetzler RF (2005) Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg 103:982–989CrossRefPubMedGoogle Scholar
  14. 14.
    Roessler K, Krawagna M, Dörfler A, Buchfelder M, Ganslandt O (2014) Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature. Neurosurg Focus 36:E7CrossRefPubMedGoogle Scholar
  15. 15.
    Sasaki T, Kodama N, Matsumoto M, Suzuki K, Konno Y, Sakuma J (2007) Blood flow disturbance in perforating arteries attributable to aneurysm surgery. J Neurosurg 107:60–67CrossRefPubMedGoogle Scholar
  16. 16.
    Suzuki K, Kodama N, Sasaki T, Matsumoto M, Ichikawa T, Munakata R, Muramatsu H, Kasuya H (2007) Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery. J Neurosurg 107:68–73CrossRefPubMedGoogle Scholar
  17. 17.
    Takagi Y, Sawamura K, Hashimoto N, Miyamoto S (2012) Evaluation of serial intraoperative surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography in patients with cerebral arteriovenous malformations. Neurosurgery 70(1 Suppl Operative):34–43PubMedGoogle Scholar
  18. 18.
    Tang G, Cawley CM, Dion JE, Barrow DL (2002) Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96:993–999CrossRefPubMedGoogle Scholar
  19. 19.
    Thornton J, Bashir Q, Aletich VA, Debrun GM, Ausman JI, Charbel FT (2000) What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46:1294–1300CrossRefPubMedGoogle Scholar
  20. 20.
    Vitaz TW, Gaskill-Shipley M, Tomsick T, Tew JM Jr (1999) Utility, safety, and accuracy of intraoperative angiography in the surgical treatment of aneurysms and arteriovenous malformations. AJNR Am J Neuroradiol 20:1457–1461PubMedGoogle Scholar
  21. 21.
    Washington CW, Zipfel GJ, Chicoine MR, Derdeyn CP, Rich KM, Moran CJ, Cross DT, Dacey RG Jr (2013) Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery. J Neurosurg 118:420–427CrossRefPubMedGoogle Scholar
  22. 22.
    Yamamoto S, Kim P, Kurokawa R, Itoki K, Kawamoto S (2012) Selective intraarterial injection of ICG for fluorescence angiography as a guide to extirpate perimedullary arteriovenous fistulas. Acta Neurochir (Wien) 154:457–463CrossRefGoogle Scholar
  23. 23.
    Yamauchi K, Nagafuji H, Nakamura T, Sato T, Kohno N (2011) Feasibility of ICG fluorescence-guided sentinel node biopsy in animal models using the HyperEye Medical System. Ann Surg Oncol 18:2042–2047CrossRefPubMedGoogle Scholar
  24. 24.
    Zaidi HA, Abla AA, Nakaji P, Chowdhry SA, Albuquerque FC, Spetzler RF (2014) Indocyanine green angiography in the surgical management of cerebral arteriovenous malformations: lessons learned in 130 consecutive cases. Neurosurgery 10(2 Suppl):246–251CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Wien 2015

Authors and Affiliations

  • Taku Sato
    • 1
    Email author
  • Kyouichi Suzuki
    • 2
  • Jun Sakuma
    • 1
  • Noboru Takatsu
    • 3
  • Yasushi Kojima
    • 3
  • Tetsuo Sugano
    • 4
  • Kiyoshi Saito
    • 1
  1. 1.Department of NeurosurgeryFukushima Medical UniversityFukushima-shiJapan
  2. 2.Department of NeurosurgeryFukushima Red Cross HospitalFukushima-shiJapan
  3. 3.Gosen FactoryMizuho CorporationGosen-shiJapan
  4. 4.Koriyama OfficeMitsubishi Electric Engineering Co., LtdKoriyama-shiJapan

Personalised recommendations