Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique

Jing, Zhitao; Ou, Shaowu; Ban, Yunchao; Tong, Zhiyong

doi:10.1016/j.jocn.2009.03.034

Cited by 34 publications

(15 citation statements)

References 11 publications

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“…7,23 One of the main advantages of DSA over ICG-VA seems to be easier identification of the aneurysm neck remnant. 9,23 This fact is also confirmed by our current study. In 9.1% of the patients, neck remnants not intraoperatively detected with ICG-VA were identified on postoperative DSA.…”

Section: Indocyanine Green Angiography and Intraoperative And Postopesupporting

confidence: 91%

“…In the literature review, deeper aneurysm locations, as in ACoA aneurysms compared with MCA aneurysms, seem to further diminish the benefits of ICG-VA. 7,9 We could not confirm this finding in our series. Image quality did not differ for deep versus superficial locations; thus, no significant difference was found in the clip adjustment rate in the most commonly investigated sites, the ACoA compared with the MCA location.…”

Section: Aneurysm Location and Icg-va Clip Adjustment Ratecontrasting

confidence: 66%

“…Therefore, postoperative ischemic deficits could be reduced. 9,20 Hence, in 2007 at our institution we started to routinely use ICG-VA during surgery for cerebral aneurysms along with intraoperative micro-Doppler examination.…”

Section: Clip Adjustment and Residual Aneurysm Ratesmentioning

confidence: 99%

“…1,5,9,16,18,20,22,23 Obviously, this high variance in the intraoperative benefit rate may be attributable to a low number of patients, inhomogeneous patient groups, and the nonsystematic application of the technique in previous studies. Thus, the general benefit of ICG-VA in aneurysm surgery is still under discussion.…”

Section: Clip Adjustment and Residual Aneurysm Ratesmentioning

confidence: 99%

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Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature

Rössler¹,

Krawagna²,

Dörfler

et al. 2014

FOC

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Object Indocyanine green (ICG) videoangiography (VA) in cerebral aneurysm surgery allows confirmation of blood flow in parent, branching, and perforating vessels as well as assessment of remnant aneurysm parts after clip application. A retrospective analysis and review of the literature were conducted to determine the current essential advantages of ICG-VA in aneurysm surgery. Methods The authors retrospectively evaluated all aneurysm cases treated with the aid of intraoperative ICG-VA at a single institution between 2007 and 2013. They also analyzed the literature published since the initial description of ICG-VA in 2003. Results Two hundred forty-six procedures were performed in 232 patients harboring 295 aneurysms. The patients, whose mean age was 54 years, consisted of 159 women and 73 men. One hundred twenty-four surgeries were performed after subarachnoid hemorrhage, and 122 were performed for incidental aneurysms. Single aneurysms were clipped in 185 patients, and multiple aneurysms were clipped in 47 (mean aneurysm diameter 6.9 mm, range 2–40 mm). No complications associated with ICG-VA occurred. Intraoperative microvascular Doppler ultrasonography was performed before ICG-VA in all patients, and postoperative digital subtraction angiography (DSA) studies were available in 121 patients (52.2%) for retrospective comparative analysis. In 22 (9%) of 246 procedures, the clip position was modified intraoperatively as a consequence of ICG-VA. Stenosis of the parent vessels (16 procedures) or occlusion of the perforators (6 procedures), not detected by micro-Doppler ultrasonography, were the most common problems demonstrated on ICG-VA. In another 11 procedures (4.5%), residual perfusion of the aneurysm was observed and one or more additional clips were applied. Vessel stenosis or a compromised perforating artery occurred independent of aneurysm location and was about equally common in middle cerebral artery and anterior communicating artery aneurysms. In 2 procedures (0.8%), aneurysm puncture revealed residual blood flow within the lesion, which had not been detected by the ICG-VA. In the postoperative DSA studies, unexpected small (< 2 mm) aneurysm neck remnants, which had not been detected on intraoperative ICG-VA, were found in 11 (9.1%) of 121 patients. However, these remnants remained without consequence except in 1 patient with a 6-mm residual aneurysm dome, which was subsequently embolized with coils. Conclusions In a large cohort of consecutive patients, ICG-VA proved to be a helpful intraoperative tool and led to a significant intraoperative clip modification rate of 15%. However, small, < 2-mm-wide neck remnants and a 6-mm residual aneurysm were missed by intraoperative ICG-VA in up to 10% of patients. Results in this study confirm that DSA is indispensable for postoperative quality assessment in complex aneurysm surgery.

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Section: Indocyanine Green Angiography and Intraoperative And Postopesupporting

confidence: 91%

Section: Aneurysm Location and Icg-va Clip Adjustment Ratecontrasting

confidence: 66%

Section: Clip Adjustment and Residual Aneurysm Ratesmentioning

confidence: 99%

Section: Clip Adjustment and Residual Aneurysm Ratesmentioning

confidence: 99%

See 2 more Smart Citations

Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature

Rössler¹,

Krawagna²,

Dörfler

et al. 2014

FOC

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“…There are several clinical applications (Table 2) and main advantages of ICG are the high contrast view, allowing only the target, not background, to be visible ( Figure 2); the dye is confined to the vascular compartment through binding with plasma proteins; low toxicity and the rapid excretion, almost exclusively into the bile. ICG does not have any known metabolites, and it is fast extracted by the liver into bile juice 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24 . Neurosurgery is ideal for ICG because operations are done under an optic microscope and camera.…”

Section: Discussionmentioning

confidence: 99%

Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Pahl¹,

Oliveira²,

Brock³

et al. 2015

Arq. Neuro-Psiquiatr.

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Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery 1,2,3,4,5 . Indocyanine green dye was developed for near-infrared photography by the Kodak Research Laboratories in 1955 and was already approved for clinical use in 1956. However, it was used for angiography in the 60´s and for retinal angiography in the 70´s. The principle of fluorescence imaging used in ICG is simple: illuminate the tissue of interest with light at the excitation wavelength (800 nm) while observing it at longer emission wavelengths (over 800 nm) 1,2,3,4,5 .Neurosurgery is ideal for ICG because operations are already done using microscope (and camera), and because the blood vessels located on the brain surface are exposed and thus can be seen more or less directly by visual means. Thus, ICG applied in vascular neurosurgical procedures has emerged as a valuable option to assess intraoperatively details of aneurysmal clipping 4,5,6,. Although with increasing reports of ICG application, there are still some points to be discussed. Additionally, Brazilian literature has no publication about such theme to the best of our knowledge. We report below the first Brazilian experience with application of ICG in the treatment of intracranial aneurysms 4,5,6 . AbstrActIndocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%-38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.Keywords: aneurysm, treatment, surgery, indocyanine green. resumo A angiografia intraoperatória com indocianina verde (ICG) já foi aplicada em diversas situações clínicas por vários anos. O ICG permite avaliação em tempo real de estruturas vasculares durante a cirurgia. Este artigo descreve os resultados cirúrgicos do autor sênior. Avaliamos retrospectivamente os casos de aneurismas intracranianos operados de 2009 a 2014. Um total de 61 aneurismas em 56 pacientes foram operados com ICG. O reposicionamento do clip ocorreu em 2 casos (3.2%). Geralmente, taxas variáveis de reposicionamento do clip têm sido descritas (2%-38%). A aplicação de ICG na neurocirurgia vascular ainda é um desafio crescente. É um artifí...

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Giant Aneurysm Management

Song

Mao

2022

Advances and Technical Standards in Neurosurgery

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Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique

Cited by 34 publications

References 11 publications

Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature

Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature

Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Giant Aneurysm Management

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