Application Of Indocyanine Green Angiography During Surgery Treatment Of Intracranial Aneurysms

Objective:Intraoperative indocyanine green(ICG) angiography is a new method of intraoperative blood flow assessment. The objective of this study is to evaluate the reliability of this technique in the evaluation of neck residuals and patency of vessels after microneurosurgical clipping of intracranial aneurysms.Method:During a period of 6 months, between September 2010 and February 2011, intraoperative ICG angiography was performed during microneurosurgical clipping of 18 intracranial aneurysms. Preoperative digital subtraction angiography(DSA) and computed tomography angiography(CTA) were performed for all patients. Intraoperative interpretation of ICG angiography in assessing the aneurysm residual or the patency of vessels after clipping of each aneurysm were recorded and correlated with postoperative CTA and/or DSA.Results:Clip reposition was necessary in 3 of 18 aneurysms(16.7%) treated. Parent artery occlusion or stenosis was documented by ICG angiography in 3 aneurysms. The information from postoperative DSA or CTA and intraoperative ICG angiography corresponded in 16 of 18 aneurysms operated on(88.9%).In one patient, aneurysm residues was documented by ICG angiography but not confirmed by DSA. In one patient, operator underestimated a perforating artery occlusion documented by ICG angiography but not confirmed by CTA, which only showed infarcted lesion.Conclusions:ICG angiography can provide real-time information to assess blood flow in vessels of size as well as the occlusion of the aneurysm. The high spatial resolution and assessment of blood flow in the perforating branches are the most important advantages. Although deep location of the aneurysm, presence of blood clots, intramural thrombi, or calcification may affect the results of the intraoperative ICG angiography, but its simplicity and celerity all suggest it to be carried out as a routine procedure during aneurysm surgery.