Lighting Up Neurovascular Surgery

Abstract

Patient care has been revolutionized by the introduction of fluorescent dyes and the incorporation of fluorescence technology in disciplines ranging from ophthalmology to neurovascular surgery. These technologies enable clinicians and surgeons to produce accurate and real-time images of difficult-to-see structures within the human body, providing a crucial step to not only understanding biological processes but also advancing treatments. Isosulfan blue, fluorescein, and 5-aminolevulinic acid have proven useful in multiple fields of medicine. Indocyanine green (ICG) is another key fluorescent dye. Combined with specialized intraoperative microscopes, it is ideal for vascular studies because it diffuses easily from vessels into the interstitial space. Ultimately, images of the vascular system within the surgical field can be observed on a video screen in real time. Today ICG allows neurosurgeons to evaluate the quality of an aneurysm clipping, the potential for residual flow in a fistula or malformation, and the patency of a bypass. With introduction of other dyes and improvements in imaging techniques, we are likely to see an expansion in application of fluorescent technology in neurosurgery and other fields, which will ultimately lead to better patient care and outcomes.

Subcutaneous Infiltration of Indocyanine Green From a Malpositioned Intravenous Catheter

“…If injected into tissues, it migrates in the lymphatic system, enabling the identification of lymphatic basins [ 2 ]. ICG has been used in the fields of cardiology, ophthalmology, neurosurgery [ 3 , 4 ], hepatology, and oncology [ 1 ].…”