Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view

Technical note

Yoshihisa Nishiyama M.D., Ph.D., Hiroyuki Kinouchi M.D., Ph.D., Nobuo Senbokuya M.D., Tatsuya Kato M.D., Kazuya Kanemaru M.D., Hideyuki Yoshioka M.D., Ph.D., and Toru Horikoshi M.D., Ph.D.
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  • Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Chuo, Yamanashi, Japan
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Recently, intraoperative fluorescence video angiography using indocyanine green (ICG) has been widely used in aneurysm surgery. This is a simple and useful method to confirm complete occlusion of the aneurysm lumen and preservation of blood flow in the arteries around the aneurysm. However, the observation field of ICG video angiography is limited under a microscope, making it difficult to confirm the flow in the arteries behind the parent arteries or aneurysm. The authors developed a new technique of intraoperative endoscopic ICG video angiography to assess the blood flow in perforating arteries hidden by the parent arteries or aneurysm. The endoscope emits excitation light with a wavelength of approximately 800 nm, and video images were obtained through a cut filter. The authors used this ICG fluorescence endoscope in treating 3 patients with unruptured cerebral aneurysms. During clip placement, the endoscope was inserted to confirm aneurysm occlusion. Then, ICG was intravenously administered, and the fluorescence in the vessels was observed via the endoscope as well as under the microscope. The blood flow in the perforating arteries was clearly identified, and no procedural complication occurred. The authors conclude that the technique is very useful and facilitates intraoperative real-time assessment of the patency of perforating arteries behind parent arteries or aneurysms.

Abbreviations used in this paper:AP = anteroposterior; CTA = CT angiography; DSA = digital subtraction angiography; ICA = internal carotid artery; ICG = indocyanine green; MCA = middle cerebral artery; PCoA = posterior communicating artery.

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Contributor Notes

Address correspondence to: Hiroyuki Kinouchi, M.D., Ph.D., Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan. email: hkinouchi@yamanashi.ac.jp.

Please include this information when citing this paper: published online June 8, 2012; DOI: 10.3171/2012.5.JNS112300.

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