Intraoperative near-infrared indocyanine green–videoangiography (ICG–VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery

Oda, Jumpei; Kato, Yōkō; Chen, S. F.; Sodhiya, Paresh; Watabe, Takeya; Imizu, Shuei; Oguri, Daikichi; Sano, Hirotoshi; Hirose, Yuichi

doi:10.1016/j.jocn.2010.12.045

Cited by 44 publications

(26 citation statements)

References 14 publications

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“…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%

“…In a comparison of clip adjustment rates in our series with rates from intraoperative DSA reports, intraoperative DSA proved twice as sensitive as ICG-VA. 19,23 Given this finding together with neck remnant rates of up to 10% with ICG-VA, 16 postoperative DSA seems indispensable for quality assurance in complex cerebral aneurysm surgery; especially in complex vascular anatomy, intraoperative ICG-VA cannot visualize all parts of the operating field after clip application. Another weakness of ICG-VA seems to be a low intravascular flow area, especially with insufficiently clipped aneurysm domes, as we found in 2 cases with clipped aneurysm domes that registered negative on ICG-VA; surprisingly, these domes bled after intraoperative needle puncture.…”

Section: Value Of Icg-va As a Substitute For Postoperative Dsamentioning

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: Clip Adjustment and Residual Aneurysm Ratesmentioning

confidence: 99%

Section: Value Of Icg-va As a Substitute For Postoperative Dsamentioning

confidence: 99%

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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“…Using the microscope integrated analytical software FLOW 800 (Carl Zeiss Meditec AG, Oberkochen, Germany [1]), fluorescence intensity in different regions of interest (ROI) can be plotted over time for objective documentation of perfusion dynamics: pixel-wise color-coded time of appearance of the fluorescence signal can provide an overview over blood flow dynamics and a better distinction between arteries and veins during cerebral vascular operations [2]. This analytical approach for quantitative assessment of blood flow characteristics was tested in patients with aneurysms [13] and arteriovenous malformations [5,8].…”

Section: Introductionmentioning

confidence: 99%

Quantitative fluorescence angiography for neurosurgical interventions

Weichelt¹,

Duscha²,

Steinmeier³

et al. 2013

Biomedizinische Technik/Biomedical Engineering

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Present methods for quantitative measurement of cerebral perfusion during neurosurgical operations require additional technology for measurement, data acquisition, and processing. This study used conventional fluorescence video angiography--as an established method to visualize blood flow in brain vessels--enhanced by a quantifying perfusion software tool. For these purposes, the fluorescence dye indocyanine green is given intravenously, and after activation by a near-infrared light source the fluorescence signal is recorded. Video data are analyzed by software algorithms to allow quantification of the blood flow. Additionally, perfusion is measured intraoperatively by a reference system. Furthermore, comparing reference measurements using a flow phantom were performed to verify the quantitative blood flow results of the software and to validate the software algorithm. Analysis of intraoperative video data provides characteristic biological parameters. These parameters were implemented in the special flow phantom for experimental validation of the developed software algorithms. Furthermore, various factors that influence the determination of perfusion parameters were analyzed by means of mathematical simulation. Comparing patient measurement, phantom experiment, and computer simulation under certain conditions (variable frame rate, vessel diameter, etc.), the results of the software algorithms are within the range of parameter accuracy of the reference methods. Therefore, the software algorithm for calculating cortical perfusion parameters from video data presents a helpful intraoperative tool without complex additional measurement technology.

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“…clipping, and to assess correct position of the clip, presence of aneurysm residuals, patency of normal vessels. Few studies focused specifically on paraclinoid aneurysms [10,19] and on quantitative blood flow study [7,12,18](which allows an objective evaluation of the results rather than the subjective assessment of fluorescence using ICG-VA). One interesting paper reports about a patient suffering from a giant aneurysm of the right MCA; indocyanine green was injected inside the aneurysm in order to identify a target middle cerebral artery branch (MCA) for bypass and allowing confident preservation of blood supply to distal areas to the sacrificed vessel [11].…”

Section: Methodsmentioning

confidence: 99%

Indocyanine green video-angiography in neurosurgery: A glance beyond vascular applications

Scerrati¹,

Pepa²,

Conforti³

et al. 2014

Clinical Neurology and Neurosurgery

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OBJECTIVE: Indocyanine green video angiography (ICG-VA) is a non invasive, easy to use and a very useful tool for various neurosurgical procedures. Initially introduced in vascular neurosurgery since 2003, it's applications have broadened over time, both in vascular applications and in other neurosurgical fields. The objective of our study is to review all published literature about ICG-VA, cataloguing its different applications. METHODS: A systematic review of all pertinent literature articles published from January 2003 to May 2014 using Pubmed access was performed using pertinent keywords; cross check of references of selected articles was performed in order to complete bibliographical research. Results of research were grouped by pathology. RESULTS AND CONCLUSIONS: The paper systematically analyses ICG-VA different applications in neurosurgery, from vascular neurosurgery to tumor resection and endoscopic applications, focusing on reported advantages and disadvantages, and discussing future perspectives. Disclosure statement: the authors declare no interest to disclose, they have any personal or institutional financial interest in drugs, materials, or devices described in this submission and that they did not receive any specific funding. The paper and any of its contents have been presented DOI Methods:A systematic review of all pertinent literature articles published from January 2003 to May 2014 using Pubmed access was performed using pertinent keywords; cross check of references of selected articles was performed in order to complete bibliographical research. Results of research were grouped by pathology. Results and ConclusionsThe paper systematically analyses ICG-VA different applications in neurosurgery, from vascular neurosurgery to tumour resection and endoscopic applications, focusing on reported advantages and disadvantages, and discussing future perspectives.

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Intraoperative near-infrared indocyanine green–videoangiography (ICG–VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery

Cited by 44 publications

References 14 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

Quantitative fluorescence angiography for neurosurgical interventions

Indocyanine green video-angiography in neurosurgery: A glance beyond vascular applications

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