Endoscope- versus microscope-integrated near-infrared indocyanine green videoangiography in aneurysm surgery

Restricted access

OBJECTIVE

The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving blood flow in the parent, branching, and perforating arteries. For a few years, there has been a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: microscope-integrated indocyanine green videoangiography (mICG-VA). This method allows for real-time information about blood flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field, especially through small craniotomies. To compensate for these drawbacks, an endoscope-integrated ICG-VA (eICG-VA) was developed. The objective of the present study was to assess the use of eICG-VA in comparison with mICG-VA for intraoperative blood flow evaluation.

METHODS

In the period between January 2011 and January 2015, 216 patients with a total of 248 intracranial saccular aneurysms were surgically treated in the Department of Neurosurgery of Saarland University Medical Center in Homburg/Saar, Germany. During 95 surgeries in 88 patients with a total of 108 aneurysms, intraoperative evaluation was performed with both eICG-VA and mICG-VA. After clipping, evaluation of complete aneurysm occlusion and flow in the parent, branching, and perforating arteries was performed using both methods. Intraoperative applicability of each technique was compared with the other and with postoperative digital subtraction angiography as a standard evaluation technique.

RESULTS

Evaluation of completeness of aneurysm occlusion and of flow in the parent, branching, and perforating arteries was more successful with eICG-VA than with mICG-VA, especially for aneurysm neck assessment (88.9% vs 69.4%). For 63.9% of the aneurysms (n = 69), both methods were equivalent, but in 30.6% of the cases (n = 33), the eICG-VA provided better results for evaluating the post-clipping situation. In 4.6% of these aneurysms (n = 5), the information given by the additional endoscope considerably changed the surgical procedure. Thus, one residual aneurysm (0.9%), two neck remnants (1.9%), and two branch occlusions (1.9%) could be prevented. Nevertheless, two incomplete aneurysm occlusions (1.9%) and six neck remnants (5.6%) were revealed by postoperative digital subtraction angiography.

CONCLUSIONS

Endoscope-integrated ICG-VA seems to be an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers higher illumination, magnification, and an extended viewing angle. Its main advantage is its ability to assess deep-seated aneurysms, especially through small craniotomies, but further studies are required.

ABBREVIATIONS AChoA = anterior choroidal artery; ACoA = anterior communicating artery; BA = basilar artery; DSA = digital subtraction angiography; eICG-VA = endoscope-integrated ICG-VA; H&H = Hunt and Hess; ICA = internal carotid artery; ICG-VA = indocyanine green videoangiography; MCA = middle cerebral artery; mICG-VA = microscope-integrated ICG-VA; SAH = subarachnoid hemorrhage.
Article Information

Contributor Notes

Correspondence Joachim Oertel: Universität des Saarlandes, Homburg, Germany. oertelj@freenet.de.INCLUDE WHEN CITING Published online November 2, 2018; DOI: 10.3171/2018.4.JNS172650.Disclosures Joachim Oertel is a consultant with Karl Storz Company.
Headings
References
  • 1

    Amin-Hanjani SMeglio GGatto RBauer ACharbel FT: The utility of intraoperative blood flow measurement during aneurysm surgery using an ultrasonic perivascular flow probe. Neurosurgery 58 (4 Suppl 2):ONS-305ONS-3122006

    • Search Google Scholar
    • Export Citation
  • 2

    Bailes JEDeeb ZLWilson JAJungreis CAHorton JA: Intraoperative angiography and temporary balloon occlusion of the basilar artery as an adjunct to surgical clipping: technical note. Neurosurgery 30:9499531992

    • Search Google Scholar
    • Export Citation
  • 3

    Bailes JETantuwaya LSFukushima TSchurman GWDavis D: Intraoperative microvascular Doppler sonography in aneurysm surgery. Neurosurgery 40:9659721997

    • Search Google Scholar
    • Export Citation
  • 4

    Balamurugan SAgrawal AKato YSano H: Intra operative indocyanine green video-angiography in cerebrovascular surgery: an overview with review of literature. Asian J Neurosurg 6:88932011

    • Search Google Scholar
    • Export Citation
  • 5

    Barrow DLBoyer KLJoseph GJ: Intraoperative angiography in the management of neurovascular disorders. Neurosurgery 30:1531591992

    • Search Google Scholar
    • Export Citation
  • 6

    Bruneau MAppelboom GRynkowski MVan Cutsem NMine BDe Witte O: Endoscope-integrated ICG technology: first application during intracranial aneurysm surgery. Neurosurg Rev 36:77852013

    • Search Google Scholar
    • Export Citation
  • 7

    Chiang VLGailloud PMurphy KJRigamonti DTamargo RJ: Routine intraoperative angiography during aneurysm surgery. J Neurosurg 96:9889922002

    • Search Google Scholar
    • Export Citation
  • 8

    Dashti RLaakso ANiemelä MPorras MHernesniemi J: Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 71:5435502009

    • Search Google Scholar
    • Export Citation
  • 9

    David CAVishteh AGSpetzler RFLemole MLawton MTPartovi S: Late angiographic follow-up review of surgically treated aneurysms. J Neurosurg 91:3964011999

    • Search Google Scholar
    • Export Citation
  • 10

    de Oliveira JGBeck JSeifert VTeixeira MJRaabe A: Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 61 (3 Suppl):63732007

    • Search Google Scholar
    • Export Citation
  • 11

    Drake CGAllcock JM: Postoperative angiography and the “slipped” clip. J Neurosurg 39:6836891973

  • 12

    Feuerberg ILindquist CLindqvist MSteiner L: Natural history of postoperative aneurysm rests. J Neurosurg 66:30341987

  • 13

    Firsching RSynowitz HJHanebeck J: Practicability of intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invasive Neurosurg 43:1441482000

    • Search Google Scholar
    • Export Citation
  • 14

    Fischer GOertel JPerneczky A: Endoscopy in aneurysm surgery. Neurosurgery 70 (2 Suppl Operative):1841912012

  • 15

    Fischer GStadie AOertel JM: Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir (Wien) 152:151915252010

    • Search Google Scholar
    • Export Citation
  • 16

    Fogelholm RHernesniemi JVapalahti M: Impact of early surgery on outcome after aneurysmal subarachnoid hemorrhage. A population-based study. Stroke 24:164916541993

    • Search Google Scholar
    • Export Citation
  • 17

    Fries GPerneczky A: Endoscope-assisted brain surgery: part 2—analysis of 380 procedures. Neurosurgery 42:2262321998

  • 18

    Hernesniemi JVapalahti MNiskanen MTapaninaho AKari ALuukkonen M: One-year outcome in early aneurysm surgery: a 14 years experience. Acta Neurochir (Wien) 122:1101993

    • Search Google Scholar
    • Export Citation
  • 19

    Hopf NJPerneczky A: Endoscopic neurosurgery and endoscope-assisted microneurosurgery for the treatment of intracranial cysts. Neurosurgery 43:133013371998

    • Search Google Scholar
    • Export Citation
  • 20

    Imizu SKato YSangli AOguri DSano H: Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope. Minim Invasive Neurosurg 51:1992032008

    • Search Google Scholar
    • Export Citation
  • 21

    Kalavakonda CSekhar LNRamachandran PHechl P: Endoscope-assisted microsurgery for intracranial aneurysms. Neurosurgery 51:111911272002

    • Search Google Scholar
    • Export Citation
  • 22

    Kallmes DFKallmes MH: Cost-effectiveness of angiography performed during surgery for ruptured intracranial aneurysms. AJNR Am J Neuroradiol 18:145314621997

    • Search Google Scholar
    • Export Citation
  • 23

    Kallmes DFKallmes MHLanzino GKassell NFJensen MEHelm GA: Routine angiography after surgery for ruptured intracranial aneurysms: a cost versus benefit analysis. Neurosurgery 41:6296411997

    • Search Google Scholar
    • Export Citation
  • 24

    Kato YSano HNagahisa SIwata SYoshida KYamamoto K: Endoscope-assisted microsurgery for cerebral aneurysms. Minim Invasive Neurosurg 43:91972000

    • Search Google Scholar
    • Export Citation
  • 25

    Katz JMGologorsky YTsiouris AJWells-Roth DMascitelli JGobin YP: Is routine intraoperative angiography in the surgical treatment of cerebral aneurysms justified? A consecutive series of 147 aneurysms. Neurosurgery 58:7197272006

    • Search Google Scholar
    • Export Citation
  • 26

    Klopfenstein JDSpetzler RFKim LJFeiz-Erfan IHan PPZabramski JM: Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg 100:2302352004

    • Search Google Scholar
    • Export Citation
  • 27

    Macdonald RLWallace MCKestle JR: Role of angiography following aneurysm surgery. J Neurosurg 79:8268321993

  • 28

    Mielke DMalinova VRohde V: Comparison of intraoperative microscopic and endoscopic ICG angiography in aneurysm surgery. Neurosurgery 10 (Suppl 3):4184252014

    • Search Google Scholar
    • Export Citation
  • 29

    Murphy MBell DWorth RDJehle KSCritchley GRNorris JS: Angiography postclipping and coiling of cerebral aneurysms. Br J Neurosurg 19:2252282005

    • Search Google Scholar
    • Export Citation
  • 30

    Nishiyama YKinouchi HSenbokuya NKato TKanemaru KYoshioka H: Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view. J Neurosurg 117:3023082012

    • Search Google Scholar
    • Export Citation
  • 31

    Perneczky ABoecher-Schwarz HG: Endoscope-assisted microsurgery for cerebral aneurysms. Neurol Med Chir (Tokyo) 38 Suppl:33341998

  • 32

    Perneczky AFries G: Endoscope-assisted brain surgery: part 1—evolution, basic concept, and current technique. Neurosurgery 42:2192251998

    • Search Google Scholar
    • Export Citation
  • 33

    Raabe ABeck JGerlach RZimmermann MSeifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:1321392003

    • Search Google Scholar
    • Export Citation
  • 34

    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 66:182005

    • Search Google Scholar
    • Export Citation
  • 35

    Raabe ANakaji PBeck JKim LJHsu FPKamerman JD: Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg 103:9829892005

    • Search Google Scholar
    • Export Citation
  • 36

    Rauzzino MJQuinn CMFisher WS III: Angiography after aneurysm surgery: indications for “selective” angiography. Surg Neurol 49:32411998

    • Search Google Scholar
    • Export Citation
  • 37

    Sindou MAcevedo JCTurjman F: Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms). Acta Neurochir (Wien) 140:115311591998

    • Search Google Scholar
    • Export Citation
  • 38

    Smith TRCote DJDasenbrock HHHamade YJZammar SGEl Tecle NE: Comparison of the efficacy and safety of endovascular coiling versus microsurgical clipping for unruptured middle cerebral artery aneurysms: a systematic review and meta-analysis. World Neurosurg 84:9429532015

    • Search Google Scholar
    • Export Citation
  • 39

    Tang GCawley CMDion JEBarrow DL: Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg 96:9939992002

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 108 108 108
Full Text Views 30 30 30
PDF Downloads 53 53 53
EPUB Downloads 0 0 0
PubMed
Google Scholar