Intraoperative localization of intracranial cavernomas by real time 3D ultrasonography: first experiences

The aim of this preliminary study was the test the feasibility of intraoperative real time 3D ultrasonography [US] in the prediction of brain cavernomas localization. During a time period of May to August 2009, 7 consecutive patients with intracranial cavernomas [3 supratentorial, 4 brainstem], were operated with the support of intraoperative true real time 3D US [iU 22, Philips, USA]. The ultrasound images were achieved in 2 simultaneous orthogonal planes to find the exact site to corticotomy. Intraoperative true real time 3D US anatomically provided detailed information and good delineation of landmarks in 5 patients [all patients with supratentorial cavernomas and 2 patients with brainstem cavernomas] with a fair delineation in 2 patients with deep-seated brainstem cavernomas. Our primary experience regarding this new technology suggests that intraoperative true real time 3D US is useful to localize cerebral cavernomas and less useful in localization of deep-seated brainstem cavernomas

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