Dual Channel Endoscopic Indocyanine Green Fluorescence Angiography for Clipping of Cerebral Aneurysms.

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Dual Channel Endoscopic Indocyanine Green Fluorescence Angiography for Clipping of Cerebral Aneurysms.

World Neurosurg. 2017 Jan 19;:

Authors: Cho WS, Kim JE, Kang HS, Ha EJ, Jung M, Lee C, Shin IH, Kang U

Abstract
OBJECTIVE: Neuroendoscopy is useful for assessing the status of perforators, parent arteries, and aneurysms beyond the straight line of microscopic view during aneurysm clipping. We aimed to evaluate the clinical usefulness of our endoscopic indocyanine green angiography (eICGA) system, which can simultaneously display both visible light and ICG fluorescent images.
METHODS: A total of 16 unruptured aneurysms in 10 patients were surgically clipped via the keyhole approach. Using our eICGA and commercial microscopic ICGA (mICGA) systems, a prospective comparison was performed in 10 targeted cerebral aneurysms at the posterior communicating (n = 4) and anterior choroidal arteries (n = 6).
RESULTS: mICGA and eICGA systems were all feasible during surgery. The mICGA could display 50% of branch orifices, 100% of branch trunks, and 20% of exact clip positions, while the eICGA system showed 100% of them. Based on eICGA findings such as incomplete clipping and compromise of parent arteries or branches, clips were repositioned in 2 cases, and additional clips were applied in 2 cases. Finally, complete occlusion and residual neck states were achieved in 6 and 4 aneurysms, respectively, after surgery. There were no neurological deficits within 3 months after surgery, except for frontalis palsy and anosmia in each patient.
CONCLUSIONS: The eICGA system with dual imaging of visible light and ICG fluorescence was very useful for assessing the geometry of aneurysms and surrounding vessels before clipping and for evaluating the completeness of clip position after clipping.

PMID: 28111312 [PubMed - as supplied by publisher]

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