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

Özgiray, Erkin; Aktüre, Erinç; Patel, Nirav J.; Baggott, Christopher; Bozkurt, Melih; Niemann, David; Başkaya, Mustafa K.

doi:10.1016/j.clineuro.2012.08.027

Cited by 39 publications

(25 citation statements)

References 22 publications

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“…ICG is a valuable tool to assess intraoperative details in vascular neurosurgical procedures 1,2,3,4,5,6 . There are several clinical applications (Table 2) and main advantages of ICG are the high contrast view, allowing only the target, not background, to be visible ( Figure 2); the dye is confined to the vascular compartment through binding with plasma proteins; low toxicity and the rapid excretion, almost exclusively into the bile.…”

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

“…Additionally, Brazilian literature has no publication about such theme to the best of our knowledge. We report below the first Brazilian experience with application of ICG in the treatment of intracranial aneurysms 4,5,6 . 1 Iamspe, Hospital do Servidor Público Estadual de São Paulo, Departamento de Neurocirurgia, Sao Paulo SP, Brazil; metHoD This study describes the surgical results of a senior vascular neurosurgeon (Pahl FH).…”

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Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Pahl¹,

Oliveira²,

Brock³

et al. 2015

Arq. Neuro-Psiquiatr.

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Indocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery 1,2,3,4,5 . Indocyanine green dye was developed for near-infrared photography by the Kodak Research Laboratories in 1955 and was already approved for clinical use in 1956. However, it was used for angiography in the 60´s and for retinal angiography in the 70´s. The principle of fluorescence imaging used in ICG is simple: illuminate the tissue of interest with light at the excitation wavelength (800 nm) while observing it at longer emission wavelengths (over 800 nm) 1,2,3,4,5 .Neurosurgery is ideal for ICG because operations are already done using microscope (and camera), and because the blood vessels located on the brain surface are exposed and thus can be seen more or less directly by visual means. Thus, ICG applied in vascular neurosurgical procedures has emerged as a valuable option to assess intraoperatively details of aneurysmal clipping 4,5,6,. Although with increasing reports of ICG application, there are still some points to be discussed. Additionally, Brazilian literature has no publication about such theme to the best of our knowledge. We report below the first Brazilian experience with application of ICG in the treatment of intracranial aneurysms 4,5,6 . AbstrActIndocyanine green (ICG) video angiography has been used for several medical indications in the last decades. It allows a real time evaluation of vascular structures during the surgery. This study describes the surgical results of a senior vascular neurosurgeon. We retrospectively searched our database for all aneurysm cases treated with the aid of intraoperative ICG from 2009 to 2014. A total of 61 aneurysms in 56 patients were surgically clipped using intraoperative ICG. Clip reposition after ICG happened in 2 patients (3.2%). Generally, highly variable clip adjustment rates of 2%-38% following ICG have been reported since the introduction of this imaging technique. The application of ICG in vascular neurosurgery is still an emerging challenge. It is an adjunctive strategy which facilitates aneurismal evaluation and treatment in experienced hands. Nevertheless, a qualified vascular neurosurgeon is still the most important component of a high quality work.Keywords: aneurysm, treatment, surgery, indocyanine green. resumo A angiografia intraoperatória com indocianina verde (ICG) já foi aplicada em diversas situações clínicas por vários anos. O ICG permite avaliação em tempo real de estruturas vasculares durante a cirurgia. Este artigo descreve os resultados cirúrgicos do autor sênior. Avaliamos retrospectivamente os casos de aneurismas intracranianos operados de 2009 a 2014. Um total de 61 aneurismas em 56 pacientes foram operados com ICG. O reposicionamento do clip ocorreu em 2 casos (3.2%). Geralmente, taxas variáveis de reposicionamento do clip têm sido descritas (2%-38%). A aplicação de ICG na neurocirurgia vascular ainda é um desafio crescente. É um artifí...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Pahl¹,

Oliveira²,

Brock³

et al. 2015

Arq. Neuro-Psiquiatr.

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“…On the other hand it has a limited view to the operating field [12,19]and in presence of blood clots, intramural thrombi, or calcifications [25], it can give a limited ability to visualize the part of the base behind the aneurysm dome in deeply located aneurysms [13,30].A percentage of unexpected neck residuals and close vessels occlusion has been reported (6% in the theDashtiHernesniemi study) [13]. Similarly the recent large aneurysm series by Ozgiray [16] et al and Washingtonet al [5]display a persistent residual flow in the aneurysm respectively in 5% and 4%.…”

Section: Aneurysmsmentioning

confidence: 99%

Indocyanine green video-angiography in neurosurgery: A glance beyond vascular applications

Scerrati¹,

Pepa²,

Conforti³

et al. 2014

Clinical Neurology and Neurosurgery

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OBJECTIVE: Indocyanine green video angiography (ICG-VA) is a non invasive, easy to use and a very useful tool for various neurosurgical procedures. Initially introduced in vascular neurosurgery since 2003, it's applications have broadened over time, both in vascular applications and in other neurosurgical fields. The objective of our study is to review all published literature about ICG-VA, cataloguing its different applications. METHODS: A systematic review of all pertinent literature articles published from January 2003 to May 2014 using Pubmed access was performed using pertinent keywords; cross check of references of selected articles was performed in order to complete bibliographical research. Results of research were grouped by pathology. RESULTS AND CONCLUSIONS: The paper systematically analyses ICG-VA different applications in neurosurgery, from vascular neurosurgery to tumor resection and endoscopic applications, focusing on reported advantages and disadvantages, and discussing future perspectives. Disclosure statement: the authors declare no interest to disclose, they have any personal or institutional financial interest in drugs, materials, or devices described in this submission and that they did not receive any specific funding. The paper and any of its contents have been presented DOI Methods:A systematic review of all pertinent literature articles published from January 2003 to May 2014 using Pubmed access was performed using pertinent keywords; cross check of references of selected articles was performed in order to complete bibliographical research. Results of research were grouped by pathology. Results and ConclusionsThe paper systematically analyses ICG-VA different applications in neurosurgery, from vascular neurosurgery to tumour resection and endoscopic applications, focusing on reported advantages and disadvantages, and discussing future perspectives.

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“…Ozgiray et al [14 ]reported 4 cases in which ICG angiography failed to demonstrate the persistent flow in the aneurysm dome, and in 1 case, it missed a residual neck. Mery et al [15 ]also reported similar inadequacies with intraoperative ICG angiography.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms

Doss¹,

Goyal

Humphries

et al. 2014

Intervent Neurol

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Background: Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature. Objective: We evaluated the correlation between ICG and DSA in clipped intracranial aneurysms. Methods: A retrospective study of patients who underwent craniotomy and microsurgical clipping of intracranial aneurysms with ICG for 2 years. Patient characteristics, presentation details, operative reports, and pre- and postclipping angiographic images were reviewed to determine the adequacy of the clipping. Results: Forty-seven patients underwent clipping with ICG and postoperative DSA: 57 aneurysms were clipped; 23 patients (48.9%) presented with subarachnoid hemorrhage. Nine aneurysms demonstrated a residual on DSA not identified on ICG (residual sizes ranged from 0.5 to 4.3 mm; average size: 1.8 mm). Postoperative DSA demonstrated no branch occlusions. Conclusion: Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. This has important clinical implications with regard to follow-up imaging and surgical/endovascular management.

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

Cited by 39 publications

References 22 publications

Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Application of indocyanine green video angiography in surgical treatment of intracranial aneurysms

Indocyanine green video-angiography in neurosurgery: A glance beyond vascular applications

Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms

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