How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration?

• Published in: Clinical neurology and neurosurgery Vol. 115; no. 7; pp. 870 - 878
• Main Authors: Özgiray, Erkin, Aktüre, Erinç, Patel, Nirav, Baggott, Christopher, Bozkurt, Melih, Niemann, David, Başkaya, Mustafa K
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.07.2013; Elsevier Limited
• Subjects: Adult; Aged; Aneurysm, Ruptured - surgery; Aneurysms; Angiography; Angiography, Digital Subtraction; Cerebral Angiography - methods; Clipping; Coloring Agents; Craniotomy; Female; Humans; ICG video angiography; Image Processing, Computer-Assisted; Indocyanine Green; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; Intracranial aneurysms; Male; Medical imaging; Middle Aged; Monitoring, Intraoperative - methods; Neurology; Neurosurgery; Neurosurgical Procedures; Patients; Postoperative period; Reproducibility of Results; Surgery; Treatment Outcome; Vascular Surgical Procedures - methods; Veins & arteries; Intracranial aneurysms; Clipping; Indocyanine green; ICG video angiography
• ISSN: 0303-8467; 1872-6968
• DOI: 10.1016/j.clineuro.2012.08.027

Abstract Introduction Indocyanine green video angiography (ICG-VA) has been recently introduced into neurovascular surgery and gained a role in assessing vessel patency and obliteration of intracranial aneurysms (IA) after clipping. Although its correlation with intra-postoperative angiography was demonstrated in previous studies, difficulties in evaluating aneurysm obliteration have not been reported. We report reliability and accuracy of ICG-VA in 109 clipped aneurysms with attention given to five cases in which ICG-VA evaluation resulted in false indication that aneurysms were secure in terms of complete obliteration. Materials and methods A retrospective chart review was performed of IAs surgically treated by a single surgeon from January 2009. In all cases, aneurysm obliteration was confirmed by a combination of microdoppler ultrasonography (MUSG), ICG-VA, and post-operative angiography. Results ICG-VA appropriately assessed vessel patency and aneurysm obliteration in 93.5% of aneurysms clipped. In four cases (3.6%), puncturing the dome of the aneurysm after satisfactory clipping revealed persistent flow within the aneurysm despite ICG-VA showing no flow after clipping. In one case (0.9%), ICG-VA showed persistent flow within the aneurysm and MUSG did not, and puncture of the dome confirmed no flow within the aneurysm. In one case (0.9%), ICG-VA failed to demonstrate residual neck. Conclusion ICG-VA is a simple and safe procedure and an important adjunct to microsurgical clipping of aneurysm. Although ICG-VA assesses vessel patency and obliteration of aneurysms in most cases, applying the principles of microsurgery in aneurysm clipping remains a main tool for obtaining the complete obliteration of aneurysm along with preservation of the normal vasculature.