Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

Abstract

Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury. Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence. In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful. ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.