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

ABSTRACT

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