Fluorescein Angiography in Intracranial Aneurysm Surgery: A Helpful Method to Evaluate the Security of Clipping and Observe Blood Flow.

Abstract

In cerebral aneurysm surgery, various tools are used to evaluate blood flow, including Doppler ultrasonography, conventional cerebral angiography, and electrophysiological monitoring. Fluorescein and indocyanine green are widely used in vascular and central nervous system tumor neurosurgery; however, their routine utilization in aneurysmal surgery is uncommon, despite the fact that they allow direct visualization of blood flow after aneurysmal sac occlusion, enabling the observation of vessel permeability and the effectiveness of aneurysmal obliteration. We report our initial experience using fluorescein video angiography as a control measure for proper clip placement and control of blood flow in aneurysm surgery, and review the relevant literature. This pilot study presents an initial experience, with enrollment of 10 patients harboring a total of 12 cerebral aneurysms who underwent surgery via clipping and subsequent fluorescence videoangiography control. The intravenous injection was performed to demonstrate the patency of the arteries adjacent to the aneurysm. Following intravenous injection, fluorescein sodium remains in the cerebral vasculature for approximately 3 minutes, providing ample time to evaluate vessel patency and determine whether clip repositioning is needed. None of the patients experienced complications during intravenous injection of fluorescein sodium, and the patency of surrounding vessels was demonstrated in all cases. Fluorescein injection in itself does not present a risk of complications, is simple to use, and offers a clear image of the cerebral vasculature. Thus, this technique is useful for determining vessel patency and the degree of aneurysmal occlusion.