Dual-Image Videoangiography During Intracranial Microvascular Surgery

Intraoperative tools for cerebral bypass surgery

“…However, the quality of image and analysis progressively declines with every administration [12]. Disadvantage of ICG-VA are the limited visualization restricted to the visible operating field [13], the poor image quality in deep operative fields (for instance in surgery of anterior communicating complex), the inability to observe structures (brain, nerve), other than NIR (near infrared) fluorescence images of vessels: the background is in fact black [14,15]. Finally, fluorescence run cannot be observed in real-time through the operating oculars.…”

“…The surgeon needs to follow the angiography on an adjacent monitor. Only the replay function allows visualization through the oculars (but not real-time) [12][13][14].…”

“…Although image contrast between vascular structures and background is higher with standard black-and-white ICG-VA, DIVA highlights vessels and provides simultaneous visualization of the surrounding structures including brain, nerves, etc. The anatomic and functional picture is clear [13,14]. DIVA seems to be superior to ICG-VA in showing the depth of the field and can be therefore useful in case of deep and narrow surgical corridor, with vascular structures located at different depths [13,14].…”

“…The anatomic and functional picture is clear [13,14]. DIVA seems to be superior to ICG-VA in showing the depth of the field and can be therefore useful in case of deep and narrow surgical corridor, with vascular structures located at different depths [13,14]. As limitation, DIVA allows visualization only of the anatomical structures exposed within the operative field (same limitation of ICG-VA).…”

“…Currently, fluorescence run cannot be observed in real-time through the operating oculars: as with ICG-VA, the surgeon needs to follow the angiography on a monitor. DIVA has been further implemented in cerebral bypass surgery allowing [13,14]: (1) verification of patency of the anastomosis, of the donor and of the recipient vessels; (2) visualization of the direction of the flow, providing a reliable estimation of flow velocity during first pass [13]. DIVA has the potential to become a widely used intraoperative tool to check patency of intracranial vessels.…”