Intra-operative indocyanine green-videoangiography [ICG-VA] in intracranial aneurysm surgery

To assess the feasibility and potential utility of the intra-operative ICG-VA in assessment of the unexpected residual aneurysm and major cerebral artery occlusion or stenosis after cerebral aneurysm surgery. Fifteen consecutive patients with anterior circulation aneurysms who underwent craniotomy and clipping of the aneurysms were included in this study. Intraoperative ICG-VA was performed in all cases after exposure of the aneurysm and the branches in the vicinity of the aneurysm or the parent vessel before clipping of the aneurysm and postclipping after the surgeon was satisfied that the aneurysm neck was completely obliterated. We analyzed the ICG images with regards to residual aneurysm or major arterial occlusion or stenosis and compared them to postoperative digital subtraction angiography [DSA] that served as a control. In 4 patients there were small residual neck detected by intraoperative ICG, which were immediately corrected by clip readjustment for immediate correction and replacement and this was confirmed by the postoperative DSA. No major arterial occlusion or stenosis was detected in ICG or postoperative DSA images. ICG-VA is a simple, fast method for blood flow assessment that provides a real-time information about the blood flow in vessels of different sizes as well as the obliteration of the aneurysm. It may serve as a method to improve the obliteration rate of intracranial aneurysms

Surgical clipping of ruptured anterior circulation cerebral aneurysms: KFMC experience

The aim of this study is to analyze the outcome of surgical clipping of the ruptured anterior circulation aneurysms with emphasis on the prognostic factors affecting this outcome. This is a retrospective study reviewing a database detailing all patients with ruptured anterior circulation aneurysm cases admitted in King Fahd Medical City from January 2006 - June 2007. Aneurysms were classified by location and size. Clinical condition was graded on admission according to classification of the World Federation of Neurological Surgeons [WFNS] grading. Outcomes were evaluated at discharge using the modified Rankin scale. Outcomes examined with overall rates of mortality, procedural complication and morbidity. Twenty-five patients, with 29 anterior circulation cerebral aneurysms underwent surgical clipping. According to WFNS, 15 patients were grade 1, 4 patients were grade 2, 4 patients were grade 3, and one patient was grade 4 and one patient was grade 5. Ten aneurysms [34.5%] were located in anterior communicating artery, 10 aneurysms [34.5%] in internal carotid artery segments, 5 aneurysms [17.2%] in anterior cerebral artery and 4 aneurysms [13.8%] in middle artery. The outcome according to Rankin score, 17 patients [68%] discharged with score 0, 3 patients [12%] with score 1, one patient [4%] with score 3, one patient [4%] with score 5 and 3 deaths [12%] score6. Surgical clipping is safe and reliable treatment of anterior circulation cerebral aneurysms. Clinical grade on admission is the most important determining factor for outcome