Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery

The goals of surgical treatment of intracranial aneurysms are to occlude the lesion and maintain blood flow in parent, branching and perforating vessels. We report our experiences in 3 cases using this method for intraoperative blood flow assessment, detection of incomplete clipping of aneurysm and to assess image quality and evaluate the clinical value of this method. A special arrangement of the filters was designed to allow the passage of near-infrared light required for the excitation of the indocyanine green [ICG] fluorescence [700 - 850 nm] from a modified microscope light source into the surgical field and the passage of ICG fluorescence [780 - 950 nm] from the surgical filed back into the optical path of the surgical microscope [Carl Zeiss, Oberkochen, Germany]. Thus, the ICG angiography could be completely performed with a surgical microscope. The reported 3 cases, one female and 2 male, either with incomplete or inadvertent clipping of the branching vessels of unruptured aneurysms were performed using ICG which was excellent in detection of incomplete or inadvertent clipping of the branching vessels

Non-traumatic cerebrospinal fluid rhinorrhea: diangosis and management

Although the majority of cerebrospinal [CSF] fistulas in the anterior skull base are traumatic in nature, the minority is non-traumatic or primary. Non-traumatic CSF leak can be a diagnostic and treatment challenge. We describe the diagnosis, modified methods of localization, and surgical repair of a series of nine patients who presented with non-traumatic CSF rhinorrhea and were managed between July 2000 and October 2002. Eight patients were managed via an endoscopic approach and one patient through an intracranial approach. The RI/T2-FLAIR test was used for localization of the site of the leak. The test confirmed the site of CSF leak in 6 patients. Successful repair of CSF rhinorrhea was achieved in 7 of 8 patients with a single endoscopic procedure; one patient required two procedures after a re-leak 18 months following the first repair. Non-traumatic CSF rhinorrhea is a relatively rare condition and occurs secondary to different etiologies. Among multiple techniques available for localization, MRI/FLAIR is effective, but requires further evaluation and polishing. In the absence of a large skull base lesion or tumor, endoscopic repair of CSF fistula carries a high success rate with a high margin of safety and low morbidity rate