Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery

Suzuki, Koichi; Kodama, Namio; Sasaki, Tatsuya; Matsumoto, Masato; Ichikawa, Tsuyoshi; Munakata, Ryoji; Muramatsu, Hiroyuki; Kasuya, Hiromichi

doi:10.3171/jns-07/07/0068

Cited by 90 publications

(38 citation statements)

References 25 publications

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“…DSA can also reveal the fate of a complex aneurysm following bypass surgery and/or trapping strategies (aneurysmal thrombosis, residual filling) [4]. Drawbacks are represented by its invasiveness, high costs, necessity of ionizing radiation, and prolonged operative time (15-60 min) [4][5][6][7].…”

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confidence: 99%

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Intraoperative tools for cerebral bypass surgery

Esposito

Regli

2018

Acta Neurochir

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mentioning

confidence: 99%

“…It can be difficult to place the probe on the target vessel in a deep surgical field. Furthermore, even if the target vessel can be touched with the probe, it may detect flow from nearby vessels: in fact, the continuous Doppler wave method detects blood flow in a relative wide region [6].…”

mentioning

confidence: 99%

Intraoperative tools for cerebral bypass surgery

Esposito

Regli

2018

Acta Neurochir

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“…ICG and fluorescein are 2 unique fluorophores used successfully as surgical adjuncts in aneurysm surgery, and, based on their unique chemical properties, they provide distinct advantages and disadvantages. 9,11 At least 3 other groups of investigators have reported the drawbacks of ICG-VA related to its poor image quality in deep operative fields. [1][2][3]10 More specifically, these investigators found a higher incidence of discordance between ICG-VA and postoperative angiograms during ACoA aneurysm surgery.…”

Section: Discussionmentioning

confidence: 99%

“…In vascular studies by Wrobel et al, 11 perforating medium and large arteries were visualized following aneurysmal clip ligation using fluorescein angiography. In 2007, Suzuki et al 9 reported on the development of a pencil-type probe with a light-emitting diode to allow fluorescein fluorescence interrogation of the arteries deep inside the surgical field. These authors reported excellent image quality and spatial resolution.…”

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confidence: 99%

A prospective comparative study of microscope-integrated intraoperative fluorescein and indocyanine videoangiography for clip ligation of complex cerebral aneurysms

Lane¹,

Bohnstedt²,

Cohen-Gadol³

2015

JNS

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T he use of fluorescent technologies in neurovascular imaging has been established with the use of indocyanine green (ICG) videoangiography in aneurysm surgery. The application of ICG was first reported in 2003 as a new method for qualitative intraoperative blood flow assessment.6 Although intraoperative digital subtraction angiography remains the gold standard to assess parent vessel patency and aneurysm obliteration, this method is time consuming, carries procedural risk, and may not assess small perforating vessels in a timely fashion. Intraoperative microvascular Doppler sonography is another tool for assessing patency of larger vessels and aneurysms; however, its utility is limited for evaluation of small perforating arteries. Therefore, intraoperative ICG fluorescence angiography is a surgical adjunct that provides a worthwhile tool for confirmation of aneurysm occlusion Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University, Indianapolis, Indiana obJect The authors prospectively analyzed 2 microscope-integrated videoangiography techniques using intravenous indocyanine green (ICG) and fluorescein for assessment of cerebral aneurysm obliteration and adjacent vessel patency. methods The authors prospectively enrolled 22 patients who underwent clip ligation of their aneurysm and used intraoperative videoangiography to assess obliteration of the aneurysmal sac and patency of the adjacent branching and perforating arteries. Patients underwent ICG videoangiography (ICG-VA) and the newly developed fluorescein videoangiography (FL-VA) using microscope-integrated fluorescence modules. Two independent observers compared the videoangiography recordings for value and quality to assess aneurysm exclusion and the patency of adjacent arteries. results All 22 patients first underwent FL-VA and then ICG-VA after clip application. In 7 cases (32%), FL-VA provided superior detail to assess perforating arteries (4 cases), distal branches (2 cases), and both (1 case); such detail was not readily available on ICG-VA. In 1 patient, ICG-VA offered better visualization of posterior communicating artery aneurysm occlusion than FL-VA because of staining artifact on the aneurysm dome from the adjacent tentorium. In 2 patients, FL-VA offered the needed advantage of real-time manipulation of the vessels and flow assessment by visualization through the operating microscope oculars. In 2 other cases, ICG-VA was more practical for repeat usage because of its more efficient clearance from the intravascular space. The ICG-VA image quality was often degraded at higher magnification in deep operative fields, partly due to chromatic aberration. Both ICG-VA and FL-VA afforded restricted views of vasculature based on the angle of surgical approach and obscuration by blood clot, aneurysm, or brain tissue. coNclusioNs Compared with ICG-VA, FL-VA can potentially provide an improved visualization of vasculature at high magnification in deep surgical fields. ICG-VA is more effective for repeated use during clip repos...

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“…This small dose is 15% of the dose previously used for neoplastic and vascular applications. 3,5,9,15,22,24 We chose this dose based on our previous experience. We had decreased fluorescein dosing gradually from 200 mg in 25 increments for the previous 10 patients who harbored brain aneurysms.…”

Section: Technique For Fluorescence Angiographymentioning

confidence: 99%

A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results

Lane

Cohen-Gadol

2014

FOC

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Object The authors report on the use of a recently developed microscope-integrated fluorescent module using low-dose intravenous fluorescein for videoangiography during arteriovenous malformation (AVM) surgery. Methods The authors analyzed the application of a low-dose intraoperative fluorescein in 4 consecutive patients undergoing AVM surgery. The ability to distinguish the associated vessels of the AVM from normal vessels and to assess the degree of AVM obliteration based on videoangiography of venous drainage was specifically analyzed. Results All 4 patients underwent fluorescein angiography without complication. In each case, videoangiography confirmed recognition of feeding arteries and draining veins through the operating oculars under the fluorescent mode. In one case involving a large frontal AVM, videoangiography demonstrated mainly cortical veins on the surface of the AVM and alerted the senior author to first tackle the feeding arteries in the interhemispheric space. While evaluating the flow within the different draining veins after most of the AVM was disconnected, videoangiography also prioritized the order for disconnection of large draining veins to allow mobilization the AVM and exposure of the remaining deep arterial feeders. In the other 3 cases, videoangiography allowed easy recognition of the angioarchitecture of the AVMs, estimated its cortical boundaries, and most importantly, assessed the flow within the draining veins before their disconnection. Conclusions The authors found fluorescein videoangiography to be a useful adjunct in resection of AVMs. This technology offers the unique ability to visualize fluorescent vessels and nonfluorescent tissues in near-natural colors simultaneously and permits microsurgical manipulation of relevant structures under the fluorescent mode. Largerscale studies are needed to establish its efficacy and wider applicability.

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Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery

Abstract: Because the fluorescein angiography procedure described here allows intraoperative confirmation of the patency of perforating arteries located deep inside the surgical field, it can be practically used for preventing unexpected cerebral infarction during aneurysm surgery.

Cited by 90 publications

References 25 publications

Intraoperative tools for cerebral bypass surgery

Intraoperative tools for cerebral bypass surgery

A prospective comparative study of microscope-integrated intraoperative fluorescein and indocyanine videoangiography for clip ligation of complex cerebral aneurysms

A prospective study of microscope-integrated intraoperative fluorescein videoangiography during arteriovenous malformation surgery: preliminary results

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