Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

Wachter, Dorothee; Behm, Timo; Eckardstein, Kajetan von; Rohde, Veit

doi:10.1227/neu.0b013e318285b846

Cited by 13 publications

(9 citation statements)

References 35 publications

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“…23 It is possible that remaining compression will also be seen with ICG angiography. The role of ICG-empowered endoscopes 24 in detecting residual compression in microvascular decompression procedures should be investigated further, and such explorations are currently underway.…”

Section: Discussionmentioning

confidence: 99%

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia

Eckardstein

Mielke

Akhavan‐Sigari

2016

J Neurol Surg A Cent Eur Neurosurg

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In microvascular decompression of the trigeminal nerve for trigeminal neuralgia (TN), the site of conflict is occasionally difficult to identify. Endoscopy has been described to better evaluate the anatomical conflict in such situations. We hypothesized that indocyanine green (ICG) angiography could allow for better visualization of the compressing artery and its anatomical relation to the nerve. ICG angiography was performed in 17 TN patients undergoing microvascular decompression. We focused on whether ICG angiography is helpful in determining the site of conflict, particularly when not directly visible via the microscope, and whether fluorescence is strong enough to shine through the nerve obliterating the direct view of the compressing vessel. In four patients, the site of conflict was immediately apparent after opening the cerebellopontine cistern, and ICG angiography did not provide the neurosurgeon with additional information. In another two patients, imaging quality and fluorescence were too poor. Of the remaining 11 patients with a hidden site of nerve-vessel conflict, ICG angiography was found to be helpful in anticipating the site of compression and the course of the artery in 7 patients, particularly in regard to the so-called shining-through effect through fiber bundles of the thinned nerve. Of all the patients, 88% reported at least improvement or cessation of their symptoms, including all of the patients with a shine-through effect. ICG angiography could be a helpful adjunct in decompressing the trigeminal nerve and can guide the surgeon to the nerve-vessel conflict. Intensity of the fluorescence is powerful enough to shine through thinned and splayed trigeminal nerve fiber bundles.

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Section: Discussionmentioning

confidence: 99%

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia

Eckardstein

Mielke

Akhavan‐Sigari

2016

J Neurol Surg A Cent Eur Neurosurg

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“…1, 4, 12 In addition, ICG angiography has the benefit of greater detail and direct visualization and the ability to covisualize nonvascular anatomical structures with light microscopy. The indications for ICG angiography have expanded since its introduction into the neurosurgical arena to include arteriovenous malformation, 16 intracranial revascularization, 1 spinal dural arteriovenous fistula, 2 intraaxial tumor resection, 3 endoscopic third ventriculostomy, 15 and microvascular decompression. 17 The use of ICG in meningioma surgery has been described, demonstrating its potential benefit in identifying adjacent venous sinuses and pial supply of the tumors.…”

Section: Discussionmentioning

confidence: 99%

Direct visualization of improved optic nerve pial vascular supply following tuberculum meningioma resection: case report

Han¹,

Magill²,

Tarapore³

et al. 2016

JNS

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Tuberculum sellae meningiomas frequently produce visual loss by direct compression from tumor, constriction of the optic nerve (ON) under the falciform ligament, and/or ON ischemia. The authors hypothesized that changes in visual function after tumor removal may be related to changes in blood supply to the ON that might be seen in the pial circulation at surgery. Indocyanine green (ICG) angiography was used to attempt to document these changes at surgery. The first patient in whom the technique was used had a left-sided, 1.4-cm, tuberculum meningioma. Time-lapse comparison of images was done postsurgery, and the comparison of video images revealed both faster initial filling and earlier complete filling of the ON pial circulation, suggesting improved pial blood flow after surgical decompression. In follow-up the patient had significant improvements in both visual acuity and visual fields function. Intraoperative ICG angiography of the ON can demonstrate measurable changes in pial vascular flow that may be predictive of postoperative visual outcome. The predictive value of this technique during neurosurgical procedures around the optic apparatus warrants further investigation in a larger cohort.

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“…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. ICG does not have any known metabolites, and it is fast extracted by the liver into bile juice 7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24 . Neurosurgery is ideal for ICG because operations are done under an optic microscope and camera.…”

Section: Discussionmentioning

confidence: 99%

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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Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

Abstract: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

Cited by 13 publications

References 35 publications

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia

Enlightening the Cerebellopontine Angle: Intraoperative Indocyanine Green Angiography in Microvascular Decompression for Trigeminal Neuralgia

Direct visualization of improved optic nerve pial vascular supply following tuberculum meningioma resection: case report

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

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