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Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery

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Abstract

The primary aim of this study is to assess the value of intraoperative near-infrared indocyanine green videoangiography (ICGA) during intracranial aneurysm surgery. Altogether, 129 patients harboring 152 intracranial aneurysms were recruited in this study between March 2007 and December 2008 and the clinical data were retrospectively analyzed. Intraoperative ICGA was performed to examine the completeness of the aneurysm clipping and the patency of the parent arteries in all cases. The intraoperative findings were compared with that of postoperative digital subtraction angiography (DSA). On all of the patients, 276 successful ICGA investigations were performed intraoperatively. The image quality and resolution were excellent, allowing real-time assessment of the cerebral circulation. Indocyanine green (ICG) angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with postoperative DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICGA findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure. Intraoperative ICG videoangiography may be a useful tool in real-time evaluation of the aneurysm clipping. Its simplicity and easy reproducibility all suggest it to be carried out as a routine procedure during aneurysm surgery.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China

    Shuo Wang, Ling Liu, Yuanli Zhao, Dong Zhang, Mingqi Yang & Jizong Zhao

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  1. Shuo Wang
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  2. Ling Liu
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  3. Yuanli Zhao
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  4. Dong Zhang
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  5. Mingqi Yang
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  6. Jizong Zhao
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Correspondence to Jizong Zhao.

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Comments

Guiseppe Lanzino, Rochester, USA

Microscope-integrated near-infrared indocyanine green (ICG) angiography is one of the main recent advances in vascular neurosurgery. It allows for intraoperative visualization of the vessels in the microscope field and is routinely utilized in aneurysm surgery to assess the degree of aneurysm occlusion, rule out parent vessel compromise, and assess patency of perforators. More recently, the role of ICG angiography has also been evaluated in brain AVM surgery, in which it may help in separating feeding arteries from draining veins. ICG also is useful in assessing the intraoperative patency of EC-IC bypasses.

In line with other studies, Wang and coworkers have confirmed the effectiveness of ICG intraoperative angiography in providing immediate feedback during aneurysm surgery. In many patients, the availability of this tool has obviated the need for intraoperative catheter-based angiography, though a limitation of ICG angiography is that it is only useful in the assessment of brain vessels along the line of sight of the microscope. This can be a major limitation especially in very large and giant aneurysms where important branches or perforators may be obscured by the mass of the aneurysm itself and not adequately visualized with this technique. Other limitations of ICG angiography include the inability to provide feedback on the amount of flow through the parent vessel or branches emanating from the aneurysm. As suggested by one case in the present report, the information provided by ICG angiography is also limited in heavily calcified vessels.

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Wang, S., Liu, L., Zhao, Y. et al. Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. Neurosurg Rev 34, 209–215 (2011). https://doi.org/10.1007/s10143-010-0305-2

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  • DOI: https://doi.org/10.1007/s10143-010-0305-2

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