J Korean Neurosurg Soc.  2013 Jun;53(6):349-355. 10.3340/jkns.2013.53.6.349.

Value of Indocyanine Green Videoangiography in Deciding the Completeness of Cerebrovascular Surgery

• Moon HS
• Joo SP
• Seo BR
• Jang JW
• Kim JH
• Kim TS

• KMID: 2190822
• DOI: http://doi.org/10.3340/jkns.2013.53.6.349

Abstract

OBJECTIVE
Recently, microscope-integrated near infrared indocyanine green videoangiography (ICG-VA) has been widely used in cerebrovascular surgery because it provides real-time high resolution images. In our study, we evaluate the efficacy of intraoperative ICG-VA during cerebrovascular surgery.
METHODS
Between August 2011 and April 2012, 188 patients with cerebrovascular disease were surgically treated in our institution. We used ICG-VA in that operations with half of recommended dose (0.2 to 0.3 mg/kg). Postoperative digital subtraction angiography and computed tomography angiography was used to confirm anatomical results.
RESULTS
Intraoperative ICG-VA demonstrated fully occluded aneurysm sack, no neck remnant, and without vessel compromise in 119 cases (93.7%) of 127 aneurysms. Eight clipping (6.3%) of 127 operations were identified as an incomplete aneurysm occlusion or compromising vessel after ICG-VA. In 41 (97.6%) of 42 patients after carotid endarterectomy, the results were the same as that of postoperative angiography with good patency. One case (5.9%) of 17 bypass surgeries was identified as a nonfunctioning anastomosis after ICG-VA, which could be revised successfully. In the two patients of arteriovenous malformation, ICG-VA was useful for find the superficial nature of the feeding arteries and draining veins.
CONCLUSION
ICG-VA is simple and provides real-time information of the patency of vessels including very small perforators within the field of the microscope and has a lower rate of adverse reactions. However, ICG-VA is not a perfect method, and so a combination of monitoring tools assures the quality of cerebrovascular surgery.

Keyword

Cerebrovascular surgery; Indocyanine green videoangiography; Intraoperative angiography; Patency of graft; Complete obliteration of aneurysm

MeSH Terms

Aneurysm
Angiography
Angiography, Digital Subtraction
Arteries
Arteriovenous Malformations
Endarterectomy, Carotid
Glycosaminoglycans
Humans
Indocyanine Green
Neck
Glycosaminoglycans
Indocyanine Green

Figure

• 

  Fig. 1 Surgical view (A, C and E) and ICG videoangiography (B, D and F) at the time of operation. All aneurysmal filling sites with fluorescent material were at the end of the clip blade. The filling pattern was typical. The brightness of fluorescence presented with two patterns; it has become brighter gradually, or it has showed "blinking sign" caused by arterial pulsation. ICG : indocyanine green.

• 

  Fig. 2 Giant aneurysm at MCA (A). After STA-M3 bypass surgery with aneurysmorrhaphy, we concerned about the weak brightness at a small perforator (black and white arrow) on ICG-VA (B and C). We repeated open and closure of the aneurysm three or four times for identification of backflow of the perforator. After operation, the patency of the perforator was retained according to postoperative DSA (D, black arrow head), and the patient had no neurological deficit, despite our concern. MCA : middle cerebral artery, STA : superficial temporal artery, ICG-VA : indocyanine green videoangiography, DSA : digital subtraction angiography.

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