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Abstract
Microscope-integrated near-infrared indocyanine green videoangiography (ICG-VA) is
a new method of intraoperative blood flow assessment. The objective of this study
was to evaluate the reliability of this technique in the evaluation of neck residuals
and patency of branches after microneurosurgical clipping of intracranial aneurysms
(IAs).
During a period of 14 months, between November 2005 and December 2006, 289 patients
with intracranial aneurysms were operated on in our institution. Intraoperative ICG-VA
was performed during microneurosurgical clipping of 239 IAs in 190 patients. Postoperative
computed tomography and computed tomography angiography (CTA) were performed for all
patients. Intraoperative interpretation of ICG-VA in assessing the neck residual or
the patency of vessels after clipping of each single aneurysm were recorded and correlated
with postoperative CTA and/or digital subtraction angiography.
Postoperative imaging studies revealed no incomplete occlusions of aneurysm domes.
Unexpected neck residuals were observed in 14 aneurysms (6%). There were no parent
artery occlusions. Unexpected branch occlusions including both major and minor branching
arteries were observed in 15 aneurysms (6%).
Indocyanine green videoangiograph is a simple and fast method of blood flow assessment
with acceptable reliability. Indocyanine green videoangiograph can provide real-time
information to assess blood flow in vessels of different size as well as the occlusion
of the aneurysm. Intraoperative assessment of blood flow in the perforating branches
is one of the most important advantages. In selected cases such as giant, complex,
and deep-sited aneurysms or when the quality of image in ICG-VA is not adequate, other
methods of intraoperative blood flow assessment should be considered.