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Universal fluorescence module for intraoperative fluorescein angiography—a technical report

  • Technical Note - Vascular Neurosurgery - Aneurysm
  • Published:
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Abstract

Background

Even in specialized centers, suboptimal aneurysm clipping can be as high as 12%. Intraoperative fluorescence angiography with indocyanine green and, more recently, fluorescein sodium have been shown to be a good method for intraoperative flow assessment. However, the cost with the apparatus it entails limits its widespread use. We have developed a low-cost universal fluorescence module (FM) designed to visualize fluorescein and perform intraoperative angiography. The purpose of this paper is to describe this device as well as to present our early experience with its use in the treatment of cerebral aneurysms.

Method

A FM was designed and built using a cyan-blue narrow bandpass (460 to 490 nm) excitation filter and a yellow-orange longpass (blocking wavelengths under 520 nm) barrier filter mounted on a 3D-printed holding tray in a specific disposition to perfectly match the light source and the objective lens of the surgical microscope. It allowed switching from white light to fluorescence mode in a simple and sterile fashion. Its perfect attachment to the microscope was possible by reusing the lens fittings extracted from used original drape sets that would otherwise be discarded. Four patients underwent aneurysm clipping using the FM at two institutions from April to September 2018.

Results

A bright green fluorescence against a dark background was observed after intravenous bolus of fluorescein. Blood vessels became obviously distinct from non-contrast-filled structures such as clipped aneurysms and the brain. Vascular anatomy could be appreciated without any distortion, including perforating arteries.

Conclusions

Intraoperative fluorescence angiography was successfully performed with the use of this universal FM after intravenous injection of fluorescein sodium. This simple and low-cost device may be useful in resource-limited centers, where other sorts of intraoperative angiography are not available.

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Figure 1
Figure 2
Figure 3

Abbreviations

DSA:

Digital subtraction angiography

FM:

Fluorescence module

ICG:

Indocyanine green

3PHT:

3D-printed holding tray

5-ALA:

5-Aminolevulinic acid

References

  1. Bongetta D, Zoia C, Pugliese R, Adinolfi D, Silvani V, Gaetani P (2016) Low-cost fluorescein detection system for high-grade glioma surgery. World Neurosurg 88:54–58

    Article  PubMed  Google Scholar 

  2. Chiang VL, Gailloud P, Murphy KJ, Rigamonti D, Tamargo RJ (2002) Routine intraoperative angiography during aneurysm surgery. J Neurosurg 96:988–992

    Article  PubMed  Google Scholar 

  3. Dashti R, Niemela M, Hernesniemi J (2007) The role of intra-operative indocyanine green videoangiography in cerebrovascular surgery. European Neurological Review (2):11–12. https://doi.org/10.17925/ENR.2007.00.02.11

  4. David CA, Vishteh AG, Spetzler RF, Lemole M, Lawton MT, Partovi S (1999) Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:396–401

    Article  CAS  PubMed  Google Scholar 

  5. Feuerberg I, Lindquist C, Lindqvist M, Steiner L (1987) Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34

    Article  CAS  PubMed  Google Scholar 

  6. Ichikawa T, Suzuki K, Watanabe Y, Sato T, Sakuma J, Saito K (2016) Development of and clinical experience with a simple device for performing intraoperative fluorescein fluorescence cerebral angiography: technical notes. Neurol Med Chir (Tokyo) 56:141–149

    Article  Google Scholar 

  7. 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 100:230–235

    Article  PubMed  Google Scholar 

  8. Kuroiwa T, Kajimoto Y, Ohta T (1998) Development of a fluorescein operative microscope for use during malignant glioma surgery: a technical note and preliminary report. Surg Neurol 50:41–48

    Article  CAS  PubMed  Google Scholar 

  9. Lane B, Bohnstedt BN, Cohen-Gadol AA (2015) A prospective comparative study of microscope-integrated intraoperative fluorescein and indocyanine videoangiography for clip ligation of complex cerebral aneurysms. J Neurosurg 122:618–626

    Article  PubMed  Google Scholar 

  10. Lipson BK, Yannuzzi LA (1989) Complications of intravenous fluorescein injections. Int Ophthalmol Clin 29:200–205

    Article  CAS  PubMed  Google Scholar 

  11. Lovato RM, Vitorino Araujo JL, Esteves Veiga JC (2017) Low-cost device for fluorescein-guided surgery in malignant brain tumor. World Neurosurg 104:61–67

    Article  PubMed  Google Scholar 

  12. Macdonald RL, Wallace MC, Kestle JR (1993) Role of angiography following aneurysm surgery. J Neurosurg 79:826–832

    Article  CAS  PubMed  Google Scholar 

  13. 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 52:132–139

    PubMed  Google Scholar 

  14. 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 103:982–989

    Article  PubMed  Google Scholar 

  15. Rey-Dios R, Cohen-Gadol AA (2013) Technical principles and neurosurgical applications of fluorescein fluorescence using a microscope-integrated fluorescence module. Acta Neurochir 155:701–706

    Article  PubMed  Google Scholar 

  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 107:68–73

    Article  PubMed  Google Scholar 

  17. Tang G, Cawley CM, Dion JE, Barrow DL (2002) Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96:993–999

    Article  PubMed  Google Scholar 

  18. Wrobel CJ, Meltzer H, Lamond R, Alksne JF (1994) Intraoperative assessment of aneurysm clip placement by intravenous fluorescein angiography. Neurosurgery 35:970–973

    Article  CAS  PubMed  Google Scholar 

  19. Yannuzzi LA, Rohrer KT, Tindel LJ, Sobel RS, Costanza MA, Shields W, Zang E (1986) Fluorescein angiography complication survey. Ophthalmology 93:611–617

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Hospital Universitário Antonio Pedro, Universidade Federal Fluminense, Rua Marques do Paraná 303, Niteroi, RJ, 24033-900, Brazil

    Rafael Teixeira Magalhaes Leal, Rafael Abbud Fernandes, Gabriel Pereira Escudeiro, Raissa Mansilla Cabrera Rodrigues & Jose Alberto Landeiro

  2. Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil

    Rui Monteiro

Authors
  1. Rafael Teixeira Magalhaes Leal
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  2. Rafael Abbud Fernandes
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  3. Gabriel Pereira Escudeiro
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  4. Raissa Mansilla Cabrera Rodrigues
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  5. Rui Monteiro
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  6. Jose Alberto Landeiro
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Correspondence to Rafael Teixeira Magalhaes Leal.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Leal, R.T.M., Fernandes, R.A., Escudeiro, G.P. et al. Universal fluorescence module for intraoperative fluorescein angiography—a technical report. Acta Neurochir 161, 1343–1348 (2019). https://doi.org/10.1007/s00701-019-03904-6

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  • DOI: https://doi.org/10.1007/s00701-019-03904-6

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