Application of indocyanine green angiography in surgery for giant intracranial aneurysm

Abstract

Objective To explore the role of intraoperative indocyanine green angiography (ICGA) in the surgery of giant intracranial aneurysm (GIA). Methods Fifty-seven patients, admitted to our hospital from March 2007 to October 2009 and performed GIA clipping and/or resection, were chosen in this study. Intraoperative ICGA was performed using a surgical microscope with integrated ICGA technology before and after GIA clipping. The presence and patency of the parent artery and perforating artery around the aneurysms, and the information of aneurysm were analyzed in the mierosurgical field during surgical dissection and clip application. Assessment of vascular patency and occlusion of aneurysm after clipping was also investigated by DSA or CTA. These findings of ICGA were compared with those of postoperative DSA. Results A total of 128 investigations were performed in these 57 patients, and 61 aneurysms were clipped and removed. ICGA could provide real-time information about the circulation of the operating field and the patency of parent, branching and perforating arteries,and the aneurysm sac. Four out of the 57 patients were noted as having significantly changed information provided by intraoperative ICGA; after adjusting the aneurysm clipping, no such unexpected findings as parent or branching artery occlusion, or aneurysm sac omission were found on postoperative angiograms;the postoperative DSA results were consistent with the intraoperative ICGA findings. Conclusion ICGA is a technique of confirming the relationship between GIA and its surrounding arteries, and monitoring aneurysm residual, parent artery stenosis and vascular anastomotic patency during the surgery. Key words: Giant intracranial aneurysms; Microsurgical surgery; Angiography