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Safety and completeness of using indocyanine green videoangiography combined with digital subtraction angiography for aneurysm surgery in a hybrid operating theater

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Abstract

This study aimed to evaluate the safety and completeness of using intraoperative indocyanine green videoangiography (ICGV) combined with intraoperative angiography (IOA) for aneurysm clipping in a hybrid operating room (hOR). All patients who underwent microsurgical clipping in the hOR were identified from prospectively maintained neurosurgical databases. Medical charts and operative videos with ICGV and IOA were reviewed to determine the adequacy of clipping, and clinical and angiographic outcomes were retrospectively analyzed. Fifty-four cerebral aneurysms (ruptured, 31; unruptured, 23) in 50 patients (mean age, 59.4 ± 10.9 y; M:F, 22:28) were evaluated with ICGV and IOA during clipping. Additional IOA led to a clip adjustment during surgery in 9/54 (16.7%) aneurysms for which ICGV had been initially performed. Post-clip perforator compromise occurred in two (3.7%) cases, with a patient with an unruptured aneurysm experiencing permanent injury (grade 3 hemiparesis) and patient with a ruptured aneurysm experiencing transient deficit. Post-clip parent vessel stenosis occurred in one (1.9%) case; however, an ischemic event did not occur because the flow patency was identified by IOA. No other patients with unruptured aneurysms developed new neurologic deficits at discharge. Favorable outcomes (Glasgow Outcome Score [GOS], 4 or 5) were observed in 26/31 patients with ruptured aneurysms. Five patients had unfavorable outcomes (GOS, 2 or 3) from the initial insult. Post-treatment angiography within 1 week showed complete occlusion in 52 (96.3%) aneurysms and minor remnants in two (3.7%) aneurysms. Using combined ICGV and IOA in a hOR may improve the safety and completeness of microsurgical aneurysm clipping.

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References

  1. Ahn SS, Kim YD (2010) Three-dimensional digital subtraction angiographic evaluation of aneurysm remnants after clip placement. J Korean Neurosurg Soc 47:185–190

    Article  Google Scholar 

  2. Brown MA, Parish J, Guandique CF, Payner TD, Horner T, Leipzig T, Rupani KV, Kim R, Bohnstedt BN, Cohen-Gadol AA (2017) A long-term study of durability and risk factors for aneurysm recurrence after microsurgical clip ligation. J Neurosurg 126:819–824

    Article  Google Scholar 

  3. Caplan JM, Sankey E, Yang W, Radvany MG, Colby GP, Coon AL, Tamargo RJ, Huang J (2014) Impact of indocyanine green videoangiography on rate of clip adjustments following intraoperative angiography. Neurosurgery 75:437–443 discussion 444

    Article  Google Scholar 

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

    Article  Google Scholar 

  5. Dammann P, Jagersberg M, Kulcsar Z, Radovanovic I, Schaller K, Bijlenga P (2017) Clipping of ruptured intracranial aneurysms in a hybrid room environment-a case-control study. Acta Neurochir 159:1291–1298

    Article  Google Scholar 

  6. Dashti R, Laakso A, Niemela M, Porras M, Celik O, Navratil O, Romani R, Hernesniemi J (2010) Application of microscope integrated indocyanine green video-angiography during microneurosurgical treatment of intracranial aneurysms: a review. Acta Neurochir Suppl 107:107–109

    Article  Google Scholar 

  7. 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 71:543–550 discussion 550

    Article  Google Scholar 

  8. 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  Google Scholar 

  9. 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 61:63–72 discussion 72-63

    Article  Google Scholar 

  10. Derdeyn CP, Moran CJ, Cross DT, Grubb RL Jr, Dacey RG Jr (1995) Intraoperative digital subtraction angiography: a review of 112 consecutive examinations. AJNR Am J Neuroradiol 16:307–318

    CAS  PubMed  Google Scholar 

  11. Doss VT, Goyal N, Humphries W, Hoit D, Arthur A, Elijovich L (2015) Comparison of intraoperative indocyanine green angiography and digital subtraction angiography for clipping of intracranial aneurysms. Interv Neurol 3:129–134

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  13. Fischer G, Stadie A, Oertel JM (2010) Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir 152:1519–1525

    Article  Google Scholar 

  14. Gruber A, Dorfer C, Standhardt H, Bavinzski G, Knosp E (2011) Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery. Neurosurgery 68:657–673 discussion 673

    Article  Google Scholar 

  15. Hardesty DA, Thind H, Zabramski JM, Spetzler RF, Nakaji P (2014) Safety, efficacy, and cost of intraoperative indocyanine green angiography compared to intraoperative catheter angiography in cerebral aneurysm surgery. J Clin Neurosci 21:1377–1382

    Article  Google Scholar 

  16. 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 146:1177–1183

    Article  CAS  Google Scholar 

  17. Kang HS, Han MH, Kwon BJ, Jung SI, Oh CW, Han DH, Chang KH (2004) Postoperative 3D angiography in intracranial aneurysms. AJNR Am J Neuroradiol 25:1463–1469

    PubMed  Google Scholar 

  18. Katz JM, Gologorsky Y, Tsiouris AJ, Wells-Roth D, Mascitelli J, Gobin YP, Stieg PE, Riina HA (2006) Is routine intraoperative angiography in the surgical treatment of cerebral aneurysms justified? A consecutive series of 147 aneurysms. Neurosurgery 58:719–727; discussion 719-727

    Article  Google Scholar 

  19. Khurana VG, Seow K, Duke D (2010) Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian neurosurgical experience. Br J Neurosurg 24:163–172

    Article  Google Scholar 

  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 100:230–235

    Article  Google Scholar 

  21. Lee JY, Park JH, Jeon HJ, Yoon DY, Park SW, Cho BM (2018) Transcervical access via direct neck exposure for neurointerventional procedures in the hybrid angiosuite. Neuroradiology 60:565–573

    Article  Google Scholar 

  22. Lopez KA, Waziri AE, Granville R, Kim GH, Meyers PM, Connolly ES Jr, Solomon RA, Lavine SD (2007) Clinical usefulness and safety of routine intraoperative angiography for patients and personnel. Neurosurgery 61:724–729 discussion 729-730

    Article  Google Scholar 

  23. Marbacher S, Mendelowitsch I, Gruter BE, Diepers M, Remonda L, Fandino J (2018) Comparison of 3D intraoperative digital subtraction angiography and intraoperative indocyanine green video angiography during intracranial aneurysm surgery. J Neurosurg 1:1–8

  24. Moon HS, Joo SP, Seo BR, Jang JW, Kim JH, Kim TS (2013) Value of indocyanine green videoangiography in deciding the completeness of cerebrovascular surgery. J Korean Neurosurg Soc 53:349–355

    Article  Google Scholar 

  25. Oda J, Kato Y, Chen SF, Sodhiya P, Watabe T, Imizu S, Oguri D, Sano H, Hirose Y (2011) Intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery. J Clin Neurosci 18:1097–1100

    Article  Google Scholar 

  26. Origitano TC, Schwartz K, Anderson D, Azar-Kia B, Reichman OH (1999) Optimal clip application and intraoperative angiography for intracranial aneurysms. Surg Neurol 51:117–124 discussion 124-118

    Article  CAS  Google Scholar 

  27. Ozgiray E, Akture E, Patel N, Baggott C, Bozkurt M, Niemann D, Baskaya MK (2013) How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration? Clin Neurol Neurosurg 115:870–878

    Article  Google Scholar 

  28. 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 discussion 139

    PubMed  Google Scholar 

  29. 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  Google Scholar 

  30. Roessler K, Krawagna M, Dorfler 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:E7

    Article  Google Scholar 

  31. Sharma M, Ambekar S, Ahmed O, Nixon M, Sharma A, Nanda A, Guthikonda B (2014) The utility and limitations of intraoperative near-infrared indocyanine green videoangiography in aneurysm surgery. World Neurosurg 82:e607–e613

    Article  Google Scholar 

  32. Simal-Julian JA, Miranda-Lloret P, Evangelista-Zamora R, Sanroman-Alvarez P, Perez de San Roman L, Perez-Borreda P, Beltran-Giner A, Botella-Asuncion C (2015) Indocyanine green videoangiography methodological variations: review. Neurosurg Rev 38:49–57 discussion 57

    Article  Google Scholar 

  33. 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 140:1153–1159

    Article  CAS  Google Scholar 

  34. 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  Google Scholar 

  35. Thornton J, Bashir Q, Aletich VA, Debrun GM, Ausman JI, Charbel FT (2000) What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46:1294–1298 discussion 1298-1300

    Article  CAS  Google Scholar 

  36. Tsutsumi K, Ueki K, Morita A, Usui M, Kirino T (2001) Risk of aneurysm recurrence in patients with clipped cerebral aneurysms: results of long-term follow-up angiography. Stroke 32:1191–1194

    Article  CAS  Google Scholar 

  37. 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 34:209–215

    Article  Google Scholar 

  38. 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 118:420–427

    Article  Google Scholar 

  39. Wermer MJ, Greebe P, Algra A, Rinkel GJ (2005) Incidence of recurrent subarachnoid hemorrhage after clipping for ruptured intracranial aneurysms. Stroke 36:2394–2399

    Article  Google Scholar 

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Acknowledgments

The authors thank the Hallym Association of Neurovascular Surgeons (HANS) for their support.

Funding

This study was supported by a grant (no. 2018–06) from the Kangdong Sacred Heart Hospital Fund.

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Authors and Affiliations

  1. Department of Neurosurgery, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, 150, Seongan-ro, Gangdong-gu, Seoul, 134-701, Republic of Korea

    Jong-Hwa Park, Jong Young Lee, Hong Jun Jeon & Byung Moon Cho

  2. Department of Neurosurgery, Dana Neurosurgical Clinic, Gangwon National University College of Medicine, 59, Jungang-ro, Chuncheon-si, Gangwon-do, 24353, Republic of Korea

    Byung Chul Lim

  3. Department of Neurosurgery, Gangwon National University Hospital, Gangwon National University College of Medicine, 156, Baengnyeong-ro, Chuncheon-si, Gangwon-do, 200-722, Republic of Korea

    Seoung Woo Park

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  1. Jong-Hwa Park
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Correspondence to Hong Jun Jeon.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of the Kangdong Sacred Heart hospital (IRB no. 2016-12-006) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Park, JH., Lee, J.Y., Jeon, H.J. et al. Safety and completeness of using indocyanine green videoangiography combined with digital subtraction angiography for aneurysm surgery in a hybrid operating theater. Neurosurg Rev 43, 1163–1171 (2020). https://doi.org/10.1007/s10143-019-01141-0

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  • DOI: https://doi.org/10.1007/s10143-019-01141-0

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