Prospective evaluation of surgical microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery

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Object. The authors prospectively compared a new technique of surgical microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography.

Method. The technique was performed during 187 surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating microscope (Carl Zeiss Co., Oberkochen, Germany). A microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography.

The results of ICG videoangiography corresponded with intra- or postoperative DS angiography in 90% of cases. The ICG technique missed mild but hemodynamically irrelevant stenosis that was evident on DS angiography in 7.3% of cases. The ICG technique missed angiographically relevant findings in three cases (one hemodynamically relevant stenosis and two residual aneurysm necks [2.7% of cases]). In two cases the missed findings were clinically and surgically inconsequential; in the third case, a 4-mm residual neck may require a second procedure. Indocyanine green videoangiography provided significant information for the surgeon in 9% of cases, most of which led to clip correction.

Conclusions. Microscope-based ICG videoangiography is simple and provides real-time information about the patency of vessels of all sizes and about the aneurysm sac. This technique may be useful during routine aneurysm surgery as an independent form of angiography or as an adjunct to intra- or postoperative DS angiography.

Article Information

Contributor Notes

Address reprint requests to: Peter Nakaji, M.D., c/o Neuroscience Publications, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013. email: neuropub@chw.edu.
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References
  • 1.

    Acevedo JCTurjman FSindou M: L'arteriographie post-operatoire dans la chirurgie des anevrismes intracraniens. Étude prospective dans une serie consective de 267 anevrismes operes. Neurochirurgie 43:2752841997Acevedo JC Turjman F Sindou M: L'arteriographie post-operatoire dans la chirurgie des anevrismes intracraniens. Étude prospective dans une serie consective de 267 anevrismes operes. Neurochirurgie 43:275–284 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Alexander TDMacdonald RLWeir BKowalczuk A: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10181996Alexander TD Macdonald RL Weir B Kowalczuk A: Intraoperative angiography in cerebral aneurysm surgery: a prospective study of 100 craniotomies. Neurosurgery 39:10–18 1996

    • Search Google Scholar
    • Export Citation
  • 3.

    Allcock JMDrake CG: Postoperative angiography in cases of ruptured intracranial aneurysm. J Neurosurg 20:7527591963Allcock JM Drake CG: Postoperative angiography in cases of ruptured intracranial aneurysm. J Neurosurg 20:752–759 1963

    • Search Google Scholar
    • Export Citation
  • 4.

    Barrow DLBoyer KLJoseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:1531591992Barrow DL Boyer KL Joseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:153–159 1992

    • Search Google Scholar
    • Export Citation
  • 5.

    Batjer HHFrankfurt AIPurdy PDSmith SSSamson DS: Use of etomidate, temporary arterial occlusion, and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:2342401988Batjer HH Frankfurt AI Purdy PD Smith SS Samson DS: Use of etomidate temporary arterial occlusion and intraoperative angiography in surgical treatment of large and giant cerebral aneurysms. J Neurosurg 68:234–240 1988

    • Search Google Scholar
    • Export Citation
  • 6.

    Chiang VLGailloud PMurphy KJRigamonti DTamargo RJ: Routine intraoperative angiography during aneurysm surgery. J Neurosurg 96:9889922002Chiang VL Gailloud P Murphy KJ Rigamonti D Tamargo RJ: Routine intraoperative angiography during aneurysm surgery. J Neurosurg 96:988–992 2002

    • Search Google Scholar
    • Export Citation
  • 7.

    Cochran STBomyea KSayre JW: Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 176:138513882001Cochran ST Bomyea K Sayre JW: Trends in adverse events after IV administration of contrast media. AJR Am J Roentgenol 176:1385–1388 2001

    • Search Google Scholar
    • Export Citation
  • 8.

    Derdeyn CPMoran CJCross DTGrubb RL JrDacey RG Jr: Intraoperative digital subtraction angiography: a review of 112 consecutive examinations. AJNR Am J Neuroradiol 16:3073181995Derdeyn CP Moran CJ Cross DT Grubb RL Jr Dacey RG Jr: Intraoperative digital subtraction angiography: a review of 112 consecutive examinations. AJNR Am J Neuroradiol 16:307–318 1995

    • Search Google Scholar
    • Export Citation
  • 9.

    Feuerberg ILindquist CLindqvist MSteiner L: Natural history of postoperative aneurysm rests. J Neurosurg 66:30341987Feuerberg I Lindquist C Lindqvist M Steiner L: Natural history of postoperative aneurysm rests. J Neurosurg 66:30–34 1987

    • Search Google Scholar
    • Export Citation
  • 10.

    Friedman WAKaplan BLDay ALSypert GWCurran MT: Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:6786871987Friedman WA Kaplan BL Day AL Sypert GW Curran MT: Evoked potential monitoring during aneurysm operation: observations after fifty cases. Neurosurgery 20:678–687 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Hope-Ross MYannuzzi LAGragoudas ESGuyer DRSlakter JSSorenson JAet al: Adverse reactions due to indocyanine green. Ophthalmology 101:5295331994Hope-Ross M Yannuzzi LA Gragoudas ES Guyer DR Slakter JS Sorenson JA et al: Adverse reactions due to indocyanine green. Ophthalmology 101:529–533 1994

    • Search Google Scholar
    • Export Citation
  • 12.

    Klopfenstein JDSpetzler RFKim LJFeiz-Erfan IHan PPZabramski JMet al: Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:2302352004Klopfenstein JD Spetzler RF Kim LJ Feiz-Erfan I Han PP Zabramski JM et al: Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:230–235 2004

    • Search Google Scholar
    • Export Citation
  • 13.

    Lee MCMacdonald RL: Intraoperative cerebral angiography: superficial temporal artery method and results. Neurosurgery 53:106710752003Lee MC Macdonald RL: Intraoperative cerebral angiography: superficial temporal artery method and results. Neurosurgery 53:1067–1075 2003

    • Search Google Scholar
    • Export Citation
  • 14.

    Macdonald RLWallace MCKestle JR: Role of angiography following aneurysm surgery. J Neurosurg 79:8268321993Macdonald RL Wallace MC Kestle JR: Role of angiography following aneurysm surgery. J Neurosurg 79:826–832 1993

    • Search Google Scholar
    • Export Citation
  • 15.

    Martin NABentson JViñuela FHieshima GReicher MBlack Ket al: Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:5265331990Martin NA Bentson J Viñuela F Hieshima G Reicher M Black K et al: Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations. J Neurosurg 73:526–533 1990

    • Search Google Scholar
    • Export Citation
  • 16.

    Meyer BUrbach HSchaller CBaslam MNordblom JSchramm J: Immediate postoperative angiography after aneurysm clipping—implications for quality control and guidance of further management. Zentralbl Neurochir 65:49562004Meyer B Urbach H Schaller C Baslam M Nordblom J Schramm J: Immediate postoperative angiography after aneurysm clipping—implications for quality control and guidance of further management. Zentralbl Neurochir 65:49–56 2004

    • Search Google Scholar
    • Export Citation
  • 17.

    Nanda AWillis BKVannemreddy PS: Selective intraoperative angiography in intracranial aneurysm surgery: intraoperative factors associated with aneurysmal remnants and vessel occlusions. Surg Neurol 58:3093152002Nanda A Willis BK Vannemreddy PS: Selective intraoperative angiography in intracranial aneurysm surgery: intraoperative factors associated with aneurysmal remnants and vessel occlusions. Surg Neurol 58:309–315 2002

    • Search Google Scholar
    • Export Citation
  • 18.

    Origitano TCSchwartz KAnderson DAzar-Kia BReichman OH: Optimal clip application and intraoperative angiography for intracranial aneurysms. Surg Neurol 51:1171281999Origitano TC Schwartz K Anderson D Azar-Kia B Reichman OH: Optimal clip application and intraoperative angiography for intracranial aneurysms. Surg Neurol 51:117–128 1999

    • Search Google Scholar
    • Export Citation
  • 19.

    Payner TDHorner TGLeipzig TJScott JAGilmor RLDeNardo AJ: Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. J Neurosurg 88:4414481998Payner TD Horner TG Leipzig TJ Scott JA Gilmor RL DeNardo AJ: Role of intraoperative angiography in the surgical treatment of cerebral aneurysms. J Neurosurg 88:441–448 1998

    • Search Google Scholar
    • Export Citation
  • 20.

    Popadic AWitzmann AAmann TDoringer WFleisch MHafel Cet al: The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients. Neuroradiology 43:4664712001Popadic A Witzmann A Amann T Doringer W Fleisch M Hafel C et al: The value of intraoperative angiography in surgery of intracranial aneurysms: a prospective study in 126 patients. Neuroradiology 43:466–471 2001

    • Search Google Scholar
    • Export Citation
  • 21.

    Raabe ABeck JGerlach RZimmermann MSeifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:1321392003Raabe A Beck J Gerlach R Zimmermann M Seifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:132–139 2003

    • Search Google Scholar
    • Export Citation
  • 22.

    Raabe ABeck JSeifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. Zentralbl Neurochir 66:182005Raabe A Beck J Seifert V: Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology. Zentralbl Neurochir 66:1–8 2005

    • Search Google Scholar
    • Export Citation
  • 23.

    Tang GCawley CMDion JEBarrow DL: Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96:9939992002Tang G Cawley CM Dion JE Barrow DL: Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96:993–999 2002

    • Search Google Scholar
    • Export Citation
  • 24.

    Thornton JBashir QAletich VADebrun GMAusman JICharbel FT: What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46:129413002000Thornton J Bashir Q Aletich VA Debrun GM Ausman JI Charbel FT: What percentage of surgically clipped intracranial aneurysms have residual necks? Neurosurgery 46:1294–1300 2000

    • Search Google Scholar
    • Export Citation
  • 25.

    Vitaz TWGaskill-Shipley MTomsick TTew JM Jr: Utility, safety, and accuracy of intraoperative angiography in the surgical treatment of aneurysms and arteriovenous malformations. AJNR Am J Neuroradiol 20:145714611999Vitaz TW Gaskill-Shipley M Tomsick T Tew JM Jr: Utility safety and accuracy of intraoperative angiography in the surgical treatment of aneurysms and arteriovenous malformations. AJNR Am J Neuroradiol 20:1457–1461 1999

    • Search Google Scholar
    • Export Citation
  • 26.

    Yanaka KAsakawa HNoguchi SMatsumaru YHyodo AAnno Iet al: Intraoperative angiography evaluation of the microsurgical clipping of unruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 42:1932012002Yanaka K Asakawa H Noguchi S Matsumaru Y Hyodo A Anno I et al: Intraoperative angiography evaluation of the microsurgical clipping of unruptured cerebral aneurysms. Neurol Med Chir (Tokyo) 42:193–201 2002

    • Search Google Scholar
    • Export Citation
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