Advertisement

Neurosurgical Review

, Volume 36, Issue 1, pp 77–85 | Cite as

Endoscope-integrated ICG technology: first application during intracranial aneurysm surgery

  • Michaël BruneauEmail author
  • Geoffrey Appelboom
  • Michal Rynkowski
  • Nathalie Van Cutsem
  • Benjamin Mine
  • Olivier De Witte
Original Article

Abstract

Microscopic indocyanine green videoangiography (mICG-VA) has gained wide acceptance during intracranial aneurysm surgery by lowering rates of incomplete clipping and occlusion of surrounding vessels. However, mICG-VA images are limited to the microscopic view and some deeper areas, including the aneurysm sac/neck posterior side, cannot be efficiently assessed as they are hidden by the aneurysm, clips, or surrounding structures. Contrarily, endoscopes allow a wider area of visualization, but neurosurgical endoscopes to date only provided visual data. We describe the first application of endoscope ICG-integrated technology (eICG) applied in an initial case of anterior communicating artery aneurysm clipping. This new technique provided also relevant information regarding aneurysm occlusion and patency of parent and branching vessels and small perforating arteries. eICG-VA provided additional information compared to mICG-VA by magnifying areas of interest and improving the ability to view less accessible regions, especially posterior to the aneurysm clip. Obtaining eICG sequences required currently the microscope to be moved away from the operating field. eICG-VA was only recorded under infrared illumination which prevented tissue handling, but white-infrared light views could be interchanged instantaneously. Further development of angled endoscopes integrating the ICG technology and dedicated filters blocking the microscopic light could improve visualization capacities even further. In conclusion, as a result of its ability to reveal structures around corners, the eICG-VA technology could be beneficial when used in combination with mICG-VA to visualize and confirm vessel patency in areas that were previously hidden from the microscope.

Keywords

Indocyanine green Intracranial aneurysm Intraoperative angiography Neuroendoscopy Surgical microscope 

Notes

Acknowledgments

We thank Jeroen Coppens, MD, for his help and Justin Neira for his video narration.

Addendum

Since the submission of the manuscript on Feb 25th 2012 another article on the same subject has been published: Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view. Nishiyama Y, Kinouchi H, Senbokuya N, Kato T, Kanemaru K, Yoshioka H, Horikoshi T. J Neurosurg. 2012 Aug;117(2):302-8. Epub 2012 Jun 8.

Grant

Michaël Bruneau, MD, PhD, received a grant from the Fond National de la Recherche Scientifique (Belgium) for supporting the microscopic infrared module installation.

Supplementary material

ESM 1

This video shows the images from the microscopic and endoscopic indocyanine green videoangiographies performed during the surgical clipping of an unruptured anterior communicating artery aneurysm (M4V 24793 kb)

References

  1. 1.
    Alexander TD, Macdonald RL, Weir B, Kowalczuk A (1996) Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39(1):10–17, discussion 17–18PubMedCrossRefGoogle Scholar
  2. 2.
    Amin-Hanjani S, Meglio G, Gatto R, Bauer A, Charbel FT (2006) The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe. Neurosurgery 58(4 Suppl 2):ONS-305–ONS-312, discussion ONS-312Google Scholar
  3. 3.
    Bailes JE, Tantuwaya LS, Fukushima T, Schurman GW, Davis D (1997) Intraoperative microvascular Doppler sonography in aneurysm surgery. Neurosurgery 40(5):965–970, discussion 970–962PubMedCrossRefGoogle Scholar
  4. 4.
    Betz CS, Zhorzel S, Schachenmayr H, Stepp H, Havel M, Siedek V, Leunig A, Matthias C, Hopper C, Harreus U (2009) Endoscopic measurements of free-flap perfusion in the head and neck region using red-excited indocyanine green: preliminary results. J Plast Reconstr Aesthet Surg 62(12):1602–1608PubMedCrossRefGoogle Scholar
  5. 5.
    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(5):543–550, discussion 550PubMedCrossRefGoogle Scholar
  6. 6.
    David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91(3):396–401PubMedCrossRefGoogle Scholar
  7. 7.
    de Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A (2007) Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 61(3 Suppl):63–72, discussion 72–63PubMedGoogle Scholar
  8. 8.
    Eloy JA, Carai A, Patel AB, Genden EM, Bederson JB (2008) Combined endoscope-assisted transclival clipping and endovascular stenting of a basilar trunk aneurysm: case report. Neurosurgery 62(3 Suppl 1):142–143, discussion 143–144PubMedCrossRefGoogle Scholar
  9. 9.
    Ensenat J, Alobid I, de Notaris M, Sanchez M, Valero R, Prats-Galino A, Ferrer E (2011) Endoscopic endonasal clipping of a ruptured vertebral-posterior inferior cerebellar artery aneurysm: technical case report. Neurosurgery 69(1 Suppl Operative):onsE121–onsE127, discussion onsE127–128PubMedGoogle Scholar
  10. 10.
    Fischer G, Oertel J, Perneczky A (2011) Endoscopy in aneurysm surgery. Neurosurgery. doi:10.3205/11dgnc265
  11. 11.
    Fischer G, Stadie A, Oertel JM (2010) Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir (Wien) 152(9):1519–1525CrossRefGoogle Scholar
  12. 12.
    Germanwala AV, Zanation AM (2011) Endoscopic endonasal approach for clipping of ruptured and unruptured paraclinoid cerebral aneurysms: case report. Neurosurgery 68(1 Suppl Operative):234–239, discussion 240PubMedGoogle Scholar
  13. 13.
    Gruber A, Dorfer C, Standhardt H, Bavinzski G, Knosp E (2011) Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery. Neurosurgery 68(3):657–673, discussion 673PubMedCrossRefGoogle Scholar
  14. 14.
    Hoh BL, Curry WT Jr, Carter BS, Ogilvy CS (2004) Computed tomographic demonstrated infarcts after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 146(11):1177–1183CrossRefGoogle Scholar
  15. 15.
    Ishihara R, Iishi H, Kidu T, Yamamoto S, Miyoshi R, Inoue T, Takeuchi Y, Higashino K, Uedo N, Tatsuta M (2008) Infrared endoscopic system for bleeding-point detection after flushing with indocyanine green solution (with videos). Gastrointest Endosc 68(5):975–981PubMedCrossRefGoogle Scholar
  16. 16.
    Kalavakonda C, Sekhar LN, Ramachandran P, Hechl P (2002) Endoscope-assisted microsurgery for intracranial aneurysms. Neurosurgery 51(5):1119–1126, discussion 1126–1117PubMedCrossRefGoogle Scholar
  17. 17.
    Kassam AB, Mintz AH, Gardner PA, Horowitz MB, Carrau RL, Snyderman CH (2006) The expanded endonasal approach for an endoscopic transnasal clipping and aneurysmorrhaphy of a large vertebral artery aneurysm: technical case report. Neurosurgery 59(1 Suppl 1):ONSE162–ONSE165, discussion ONSE162–165PubMedGoogle Scholar
  18. 18.
    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(6):989–995PubMedCrossRefGoogle Scholar
  19. 19.
    Kivisaari RP, Porras M, Ohman J, Siironen J, Ishii K, Hernesniemi J (2004) Routine cerebral angiography after surgery for saccular aneurysms: is it worth it? Neurosurgery 55(5):1015–1024PubMedCrossRefGoogle Scholar
  20. 20.
    Klopfenstein JD, Spetzler RF, Kim LJ, Feiz-Erfan I, Han PP, Zabramski JM, Porter RW, Albuquerque FC, McDougall CG, Fiorella DJ (2004) Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100(2):230–235PubMedCrossRefGoogle Scholar
  21. 21.
    Leveque M, McLaughlin N, Laroche M, Bojanowski MW (2011) Endoscopic treatment of distal choroidal artery aneurysm. J Neurosurg 114(1):116–119PubMedCrossRefGoogle Scholar
  22. 22.
    Litvack ZN, Zada G, Laws ER Jr (2012) Indocyanine green fluorescence endoscopy for visual differentiation of pituitary tumor from surrounding structures. J Neurosurg 116(5):935–941PubMedCrossRefGoogle Scholar
  23. 23.
    Ma CY, Shi JX, Wang HD, Hang CH, Cheng HL, Wu W (2009) Intraoperative indocyanine green angiography in intracranial aneurysm surgery: microsurgical clipping and revascularization. Clin Neurol Neurosurg 111(10):840–846PubMedCrossRefGoogle Scholar
  24. 24.
    Macdonald RL, Wallace MC, Kestle JR (1993) Role of angiography following aneurysm surgery. J Neurosurg 79(6):826–832PubMedCrossRefGoogle Scholar
  25. 25.
    Perneczky A, Boecher-Schwarz HG (1998) Endoscope-assisted microsurgery for cerebral aneurysms. Neurol Med Chir (Tokyo) 38(Suppl):33–34CrossRefGoogle Scholar
  26. 26.
    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(1):132–139, discussion 139PubMedGoogle Scholar
  27. 27.
    Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, 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(6):982–989PubMedCrossRefGoogle Scholar
  28. 28.
    Secer HI, Duz B, Solmaz I, Gonul E (2010) Endoscopic clipping of a middle cerebral artery aneurysm in a middle fossa arachnoid cyst and review of the literature. Minim Invasive Neurosurg 53(3):132–137PubMedCrossRefGoogle Scholar
  29. 29.
    Sindou M, Acevedo JC, Turjman F (1998) Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir (Wien) 140(11):1153–1159CrossRefGoogle Scholar
  30. 30.
    Tang G, Cawley CM, Dion JE, Barrow DL (2002) Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96(6):993–999PubMedCrossRefGoogle Scholar
  31. 31.
    Taniguchi M, Takimoto H, Yoshimine T, Shimada N, Miyao Y, Hirata M, Maruno M, Kato A, Kohmura E, Hayakawa T (1999) Application of a rigid endoscope to the microsurgical management of 54 cerebral aneurysms: results in 48 patients. J Neurosurg 91(2):231–237PubMedCrossRefGoogle Scholar
  32. 32.
    Thines L, Dehdashti AR, Howard P, Da Costa L, Wallace MC, Willinsky RA, Tymianski M, Lejeune JP, Agid R (2010) Postoperative assessment of clipped aneurysms with 64-slice computerized tomography angiography. Neurosurgery 67(3):844–853, discussion 853–844PubMedCrossRefGoogle Scholar
  33. 33.
    Turhan T, Ersahin Y (2011) Near-infrared camera for intraventricular neuroendoscopic procedures: in vitro comparison of the efficiency of near-infrared camera and visual light camera during bleeding. Childs Nerv Syst 27(3):439–444PubMedCrossRefGoogle Scholar
  34. 34.
    Wang S, Liu L, Zhao Y, Zhang D, Yang M, Zhao J (2010) Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. Neurosurg Rev 34(2):209–215PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Michaël Bruneau
    • 1
    Email author
  • Geoffrey Appelboom
    • 1
  • Michal Rynkowski
    • 1
  • Nathalie Van Cutsem
    • 2
  • Benjamin Mine
    • 3
  • Olivier De Witte
    • 1
  1. 1.Department of Neurosurgery, Erasme HospitalUniversité Libre de Bruxelles–ULBBrusselsBelgium
  2. 2.Department of Anesthesiology, Erasme HospitalUniversité Libre de Bruxelles–ULBBrusselsBelgium
  3. 3.Department of Interventional Neuroradiology, Erasme HospitalUniversité Libre de Bruxelles–ULBBrusselsBelgium

Personalised recommendations