Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery

Abstract

Both techniques have specific drawbacks that could be compensated by each other, to a certain extent. Intraoperatively, ICG-VA and mDs should not be considered competitive, but complementary. This study implicates that the combination of both applications on a routine basis assures the quality of aneurysm surgery by nearly noninvasive and cost-effective techniques. However, DSA remains the gold standard for evaluation of aneurysm occlusion.

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

“…The first application was in neurovascular surgery, because it was born as an intravascular tracer for vessels visualization [12];…”

“…clipping, and to assess correct position of the clip, presence of aneurysm residuals, patency of normal vessels. Few studies focused specifically on paraclinoid aneurysms [10,19] and on quantitative blood flow study [7,12,18](which allows an objective evaluation of the results rather than the subjective assessment of fluorescence using ICG-VA). One interesting paper reports about a patient suffering from a giant aneurysm of the right MCA; indocyanine green was injected inside the aneurysm in order to identify a target middle cerebral artery branch (MCA) for bypass and allowing confident preservation of blood supply to distal areas to the sacrificed vessel [11].…”

“…During aneurysms surgery its use is already consolidated, it's easy, rapid to perform and non invasive [12]; it has a good spatial resolution [13][14] and allows a good evaluation of the complete aneurysm exclusion, neck remnant, blood flow in the parent arteries and perforating arteries [12,14]. 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].…”

“…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%.…”

Intraoperative indocyanine green video angiography in cerebrovascular surgery

“…Совпадение данных ИЦЗ ВА с результата-ми, полученными с помощью более дорогих и тру-доемких методов исследования, достигает 90-100% при выполнении микрохирургического клипирова-ния артериальных аневризм и наложении байпасов [6][7][8]. Выполнение дигитальной субтракционной ангиографии даже при наличии команды с большим опытом требует затрат времени не менее 20 мин.…”