Abstract
Background The introduction of indocyanine green videoangiography (ICGV) has impacted significantly the practice of operative microneurosurgery over the past decade. Several clinical studies have compared the use of ICGV to conventional catheter intraoperative digital subtraction angiography (DSA) during aneurysm surgery. We describe our experience with the combined use of ICGV and DSA in this setting. Material & Methods From January 2010 to December 2012, we performed both ICGV and intraoperative DSA in 235 consecutive aneurysm surgeries. Immediately after clip placement, ICGV was performed; if a problem was identified, the clip was removed and then repositioned or additional clips were added and ICGV repeated. Once the ICGV appearance was acceptable, DSA was then performed by an interventional neuroradiologist through a femoral arterial sheath that was placed either immediately preoperatively or during surgery. The number of cases in which ICGV as well as subsequent DSA resulted in clip repositioning or additional clip placement was assessed. Results Diagnostic images were obtained using ICGV in 230 of 235 cases and using DSA in 234 of 235 cases. After aneurysm clipping, ICGV resulted in clip removal and repositioning in seven cases when poor distal flow was encountered and the addition of extra clips in six cases to address clear residual aneurysm filling. When ICGV appeared satisfactory, DSA then resulted in clip repositioning in four instances of parent artery stenosis and the addition of extra clips in five cases of large, giant, or atheromatous aneurysms when additional filling not seen with ICGV was detected. Overall, ICGV resulted in a change in 13 cases, and then subsequent DSA resulted in a change in an additional nine cases. Our combined paradigm thus effected a change in the surgery in a total of 22 cases (9.3%). Conclusion In our experience, ICGV carries the distinct advantages of rapid feedback of information and excellent visualization of local perforators, while DSA provides optimal visualization of residual aneurysm and non-flow-limiting parent artery stenosis. Their combined use may provide optimal information to microsurgeons who continue to operate on intracranial aneurysms.
Highlights
In the past decade, indocyanine green videoangiography (ICGV) has made a significant impact in the field of neurovascular surgery [1,2,3,4,5,6,7]
When ICGV appeared satisfactory, digital subtraction angiography (DSA) resulted in clip repositioning in four instances of parent artery stenosis and the addition of extra clips in five cases of large, giant, or atheromatous aneurysms when additional filling not seen with ICGV was detected
ICGV resulted in a change in 13 cases, and subsequent DSA resulted in a change in an additional nine cases
Summary
Indocyanine green videoangiography (ICGV) has made a significant impact in the field of neurovascular surgery [1,2,3,4,5,6,7]. Several clinical studies have compared the use of ICGV to conventional catheter intraoperative digital subtraction angiography (DSA) as methods to approach aneurysm surgery [8]. We have found the combined use of ICGV and DSA may represent the most effective strategy for maximizing the safety and efficacy of aneurysm surgery, as each method offers different, yet complementary information. This report details our experience with a policy combining the routine use of DSA and ICGV for intraoperative assessment during aneurysm surgery. Several clinical studies have compared the use of ICGV to conventional catheter intraoperative digital subtraction angiography (DSA) during aneurysm surgery. We describe our experience with the combined use of ICGV and DSA in this setting
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