Intraoperative aneurysmal rupture (IAR) is the most fearsome complication of aneurysm surgery. IAR associates with high morbidity and mortality. In recent years, we have many studies regarding using computational fluid dynamics (CFD) in aneurysm surgery. CFD helps in calculating the velocity of blood flowing in the aneurysm sac, the pressure in the aneurysm sac, and wall shear stress (WSS). CFD also helps in predicting nature of aneurysm wall and thus may warn about different intraoperative microscopy findings in aneurysms. Using its application, surgeon may become more careful in doing microsurgical sharp dissection. A 40-year-old female admitted with diagnosis of unruptured anterior communicating artery aneurysm. CFD analysis demonstrated high intra-aneurysmal pressure and divergent WSS in dome. During sharp dissection, there was intraoperative rupture aneurysm twice which was managed with cotton tamponade and glue and temporary clipping aneurysm. Indocyanine green video angiography showed working parent arteries and nonfunctioning aneurysm. After operation, the patient recovered fully and had a modified Rankin score of 1. This case demonstrated importance of preoperative planning of aneurysm surgery using CFD analysis. IAR is associated with an increased risk for an unfavorable outcome. Accurate preoperative planning with studying flow dynamics and structure of aneurysm may help in use sharp microsurgical dissection more cautiously.

The dual-image videoangiography (DIVA) is a new tool which helps identify vessels and surrounding structure. This method is based on use of indocyanine green video angiography (ICG-VA) technology on real time microscopic operative image. In this two case, we report of using DIVA in STA-MCA bypass surgery of 46 years old, female patient of stenosis of right MCA. And using DIVA during clipping ICA paraclinod aneurysm of 35 years old, female. During surgery, it helped in identifying temporal and frontal branches of the STA and there careful selection. After anastomosis, DIVA was used to refine vessel patency and functioning of the anastomosis. DIVA has the potential to replace ICG-VA as a tool for checking the patency of graft during bypass procedures and obliteration of aneurysm along with surgical procedures for AVM and d-AVF. DIVA allows visualization of vessels against a background of normal brain and has better visualization at greater depth and high magnification. This is particularly important during bypass surgery, which very often is performed in deep surgical fields and high magnification.

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