Abstract
In the present study, we assess whether a new technique of surgical microscope-based videoangiography (VAG) using indocyanine green (ICG) is suitable for confirming a patent extracranial-intracranial bypass or a complete aneurysmal clipping. We also describe the usefulness of our approach combined with ICG-VAG and motor evoked potentials (MEP) for the intraoperative assessment of blood flow in cerebral arteries of clipping or bypass operations. We clinically and scientifically tested ICG VAG in 22 patients. In each patient, ICG (0.10-0.50 mg/kg body weight) was given systemically via an intravenous bolus injection. We used the Carl Zeiss Surgical Microscope OPMI Pentero INFRARED 800 system (Carl Zeiss Co., Tokyo, Japan). Images of ICG video angiography were excellent and permitted a real-time surgical assessment if the structures of interest were visible to the surgeon under the microscope. The visible structures included venous vessels or perforating arteries with a diameter of less than 0.3 mm. Of the 22 patients operated on, none suffered surgically related complications. ICG VAG is a simple, reliable method, and its real-time character allows the early confirmation of complete aneurysmal clipping in patient bypass surgery. This technique may improve neurosurgical procedures and reduce the application of intra- or postoperative digital subtraction angiography.
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