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Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery

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Abstract

Introduction

The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion and restoration of flow in the parent, branching and perforating vessels. In postoperative digital subtraction angiography (DSA), unexpected aneurysm residuals and vessel occlusions are frequently detected. Here, the value of two nearly noninvasive and cost-effective techniques for intraoperative flow evaluation (near-infrared indocyanine green video angiography (ICG-VA) and microvascular Doppler sonography (mDs)) is investigated in a prospective study.

Patients and methods

Over a period of 10 months, the authors surgically clipped 50 aneurysms under intraoperative pre- and post-clipping evaluation of flow in the parent, branching and perforating vessels and the aneurysm sack by the two techniques. Intraoperative applicability of each technique was compared to each other and to postoperative digital subtraction angiography as standard evaluation technique.

Results

Forty-five aneurysms were totally occluded without vessel compromise (90%). Intraoperatively, ICG-VA was considered useful in 43 cases (86%) and mDs in 44 cases (88%), respectively. Both techniques could compensate each other’s weak points to a certain degree; but two branch occlusions (4%) and three neck remnants (6%) were revealed by postoperative DSA.

Conclusion

Both techniques have specific drawbacks that could be compensated by each other, to a certain extent. Intraoperatively, ICG-VA and mDs should not be considered competitive, but complementary. This study implicates that the combination of both applications on a routine basis assures the quality of aneurysm surgery by nearly noninvasive and cost-effective techniques. However, DSA remains the gold standard for evaluation of aneurysm occlusion.

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Acknowledgement

The authors gratefully acknowledge Mr. S. Kindel’s expert support in the preparation of the figures.

Disclosure

J Oertel is a consultant of Karl Storz company but there is no relation to this study.

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Authors and Affiliations

  1. Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universitaet, Langenbeckstrasse 1, 55131, Mainz, Germany

    Gerrit Fischer, Axel Stadie & Joachim M. K. Oertel

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  1. Gerrit Fischer
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  2. Axel Stadie
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  3. Joachim M. K. Oertel
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Correspondence to Joachim M. K. Oertel.

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This manuscript has not been previously published in whole or in part, or submitted elsewhere for review. The work presented in this manuscript was not supported. The authors have nothing to disclose.

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Fischer, G., Stadie, A. & Oertel, J.M.K. Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir 152, 1519–1525 (2010). https://doi.org/10.1007/s00701-010-0723-5

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  • DOI: https://doi.org/10.1007/s00701-010-0723-5

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