119 Visualization of Vascular Structures of the Brain Through a Novel Multispectral Fluorescence Microscope After Intravenous Application of ICG

Abstract

Abstract INTRODUCTION Vascular structures are intraoperatively visualized through the eye-piece of a surgical microscope. The blood flow within the blood vessels can be demonstrated via indocyanine green (ICG) fluorescence. In this study we wanted to find out whether the development of a novel fluorescent surgical microscope, overlapping a multispectral fluorescent image on a white light image, is superior, equal or inferior, compared to the previous models. Moreover, it shall be proved, whether multispectral fluorescence enhances surgeon's orientation through the precise and clearer visualization of blood vessels and the blood flow. METHODS A total of 8 porcine animal models were used. After fixation of the animal's head the parietal cortex and the cortical blood vessels were exposed. A digital imaging of the arterial perfusion, capillary transition and venous drainage after intravenous injection of ICG (5 ml; 5 mg/ml) was then performed. The blood flow was artificially blocked by a surgical clip. After repetitive intravenous injection of ICG and visualisation with multispectral view, the surgical clip was removed and the reperfusion of the brain tissue was visualized with the real time ICG perfusion. RESULTS >The visualization of the anatomical structures of the surgical field under white light as well as the image overlapping were easily performed. The occlusion of blood vessels with surgical clips demonstrate a blockage of the ICG perfusion on the multispectral fluorescent image. The ICG perfusion was again demonstrated after removing the surgical clip and reperfusion of the blood vessel. CONCLUSION Multispectral fluorescence was shown to be superior to the classic ICG fluorescence. With the development of a novel multispectral surgical microscope, which overlaps a fluorescent image on a white light image, the data delivered to the surgeon are enhanced, compared to the previous models. Moreover, the surgeons's orientation is improved thanks to the clear visualization of blood vessels and the blood flow.