Quantitative Comparison of the Intraoperative Utility of Indocyanine Green and Fluorescein Videoangiographies in Cerebrovascular Surgery

Abstract

In this quantitative analysis of fluorescence study, ICG-VAG showed greater efficacy than FL-VAG in visualizing relatively thick arteries, such as parent artery and STA. However, FL-VAG has greater efficacy than ICG-VAG in visualizing perforating artery, especially in deep surgical fields with characteristic vessel walls.

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 same microscope can also be equipped with integrated ICG-VA and FLOW-800 modules. Matano et al [15] reported on the central intravenous administration of a 250 mg bolus dose of fluorescein, and Narducci et al [12] on the administration of 500 mg through a peripheral vein. As ICG, sodium fluorescein is easy to administer and inexpensive.…”

“…Fluorescence is observable with a latency between 15 and 20 s after administration: arterial, capillary, and venous phases can be clearly defined. The surgeon visualizes the angiography directly through the microscope oculars, without the necessity to interrupt the procedure to look at an adjacent monitor [12,15]. Manipulation of the vessels during videoangiography is possible.…”

“…It is possible to safely repeat administration, since the dose of sodium fluorescein commonly used in other fields (i.e., glioma surgery) is up to 20 mg/kg [12,22]. If necessary, f-VA can be repeated after 20-25 min, following clearance of most of the fluorescent signal: this is something more than the 10-15 min needed to repeat an ICG run [12,15].…”

“…The main limitations, in comparison with ICG-VA, are (1) the lower-sensitivity in flow-velocity assessment during first pass, (2) the absence of an integrated software for analysis of the temporal distribution of the dye (i.e., FLOW 800), and (3) the prolonged clearance time of the fluorescein, in comparison with ICG [15].…”