Intraoperative Indocyanine Green Videoangiography in Intracerebral Aneurysm Surgery

Abstract

This study evaluates results of Indocyanine Green Videoangiography (ICG-VA) in a patient group with intracerebral aneurysms. To assess reliability of this technique, ICG-VA findings were compared with postoperative cerebral angiography. Furthermore, benefits and limitations of this intraoperative evaluation method were discussed. This study includes 75 aneurysms in 61 consecutive patients. Following clip ligation of the aneurysm, ICG was administrated intravenously to observe the aneurysm, parent arteries, and perforating arteries. All patients under-went postoperative angiography before discharge. In 86.6% of aneurysms, ICG-VA confirmed satisfactory clip application and was concor-dant with postoperative angiography. In 6.6% of aneurysms, ICG-VA showed pathological findings intraoperatively leading to readjustment of clips immediately. In another 6.6% of aneurysms, ICG-VA did not reveal any pathological findings intraoperatively while postoperative angiography was not normal in these cases. ICG-VA cannot replace the intraoperative angiography yet as the gold standard method of int-raoperative blood assessment. However, this technique adds greatly to the safety of the surgical treatment of intracranial aneurysms. ICG-VA promoted real time assessment of the surgical field with good image quality. It is easy to perform and evaluate the procedure. This technique has the potential to be considered as a standard step of this surgical intervention.

Keywords

• aneurysm
• angiography
• clip ligation
• indocyanine green videoangiography
• microsurgery

Beyin Anevrizmalarının Cerrahi Tedavisinde Indocyanine Green Videoanjiyografi Kullanımı

Abstract

Bu çalışmada, beyin anevrizması nedeniyle cerrahi tedavi uygulanan bir hasta grubunda İndosiyanin Yeşili Videoanjiyografi (ICG-VA) yönteminin sonuçlarının değerlendirilmesi amaçlanmıştır. Bu intraoperatif değerlendirme yönteminin güvenilirliğini saptamak için, ICG-VA bulguları postoperative anjiyografi ile karşılaştırılmıştır ve bu yöntemin faydaları ve kısıtlılıkları tartışılmıştır. Bu çalışmaya, 75 anevrizma saptanan altmış bir ardışık hasta dahil edilmiştir. Anevrizmanın kliplenmesini takiben; anevrizmayı, ana arterleri ve perforan arterleri göz-lemlemek için intravenöz yoldan ICG uygulandı. Ameliyat sonrasında tüm hastalara taburculuk öncesi anjiyografi yapıldı. Anevrizmala-rın %86,6'sında, ICG-VA tatmin edici klipleme sağlandığını gösterdi ve ICG-VA bulguları postoperatif anjiyografi ile uyumluydu. Anevriz-maların %6.6'sında, anormal ICG-VA bulguları saptandı ve kliplerin değiştirilmesi veya düzeltilmesi gerekli oldu. Anevrizmaların bir di-ğer % 6.6'sında ise, ICG-VA herhangi bir patolojik bulgu göstermezken postoperatif anjiyografide anormal bulgular saptandı. ICG-VA ameliyat esnasında kan akımının değerlendirmesinde altın standart yöntem olan intraoperatif anjiyografinin yerini almamakla birlikte, beyin anevrizmalarının cerrahi tedavisinde hasta güvenliğine büyük katkıda bulunmaktadır. ICG-VA, iyi görüntü kalitesiyle cerrahi alanın gerçek zamanlı değerlendirilmesini mümkün kılmaktadır. İşlemi gerçekleştirmek ve değerlendirmek kolaydır. Bu teknik, anevrizma cerrahisinin standart bir uygulaması olarak değerlendirilmelidir.

Keywords

• anevrizma
• anjiyografi
• klipleme
• indosiyanin yeşili videoanjiyografi
• mikrocerrahi

References

1. 1. Dashti R, Laakso A, Niemela M, Porras M, Hernesniemi J. Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol. 2009;71(5): 543-550.
2. 2. Dashti R, Laakso A, Niemela M, Porras M, Hernesniemi J. Microscope integrated indocyanine green video-angiography in cerebrovascular surgery. Acta Neurochir Suppl. 2011;109: 247-250.
3. 3. Kucukyuruk B, Korkmaz TS, Nemayire K, et al. Intraoperative Fluorescein Sodium Videoangiography in Intracranial Aneurysm Surgery. World Neurosurg. 2020.
4. 4. Riva M, Amin-Hanjani S, Giussani C, De Witte O, Bruneau M. Indocyanine Green Videoangiography in Aneurysm Surgery: Systematic Review and Meta-Analysis. Neurosurgery. 2018;83(2): 166-180.
5. 5. Derdeyn CP, Moran CJ, Cross DT, 3rd, Sherburn EW, Dacey RG, Jr. Intracranial aneurysm: anatomic factors that predict the usefulness of intraoperative angiography. Radiology. 1997;205(2): 335-339.
6. 6. Tang G, Cawley CM, Dion JE, Barrow DL. Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg. 2002;96(6): 993-999.
7. 7. Hashimoto K, Kinouchi H, Yoshioka H, et al. Efficacy of Endoscopic Fluorescein Video Angiography in Aneurysm Surgery-Novel and Innovative Assessment of Vascular Blood Flow in the Dead Angles of the Microscope. Oper Neurosurg (Hagerstown). 2017;13(4): 471-481.
8. 8. Lane B, Bohnstedt BN, Cohen-Gadol AA. A prospective comparative study of microscope-integrated intraoperative fluorescein and indocyanine videoangiography for clip ligation of complex cerebral aneurysms. J Neurosurg. 2015;122(3): 618-626.

9. 9. de Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A. Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery. 2007;61(3 Suppl): 63-72.
10. 10. Raabe 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. 2003;52(1): 132-139.
11. 11. Doss VT, Goyal N, Humphries W, Hoit D, Arthur A, Elijovich L. Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms. Interv Neurol. 2015;3(3-4): 129-134.
12. 12. Fischer G, Stadie A, Oertel JM. Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery. Acta Neurochir (Wien). 2010;152(9): 1519-1525.
13. 13. Sharma M, Ambekar S, Ahmed O, et al. The utility and limitations of intraoperative near-infrared indocyanine green videoangiography in aneurysm surgery. World Neurosurg. 2014;82(5): e607-613.
14. 14. Akdemir H, Oktem IS, Tucer B, Menku A, Basaslan K, Gunaldi O. Intraoperative microvascular Doppler sonography in aneurysm surgery. Minim Invasive Neurosurg. 2006;49(5): 312-316.
15. 15. Gruber A, Dorfer C, Standhardt H, Bavinzski G, Knosp E. Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery. Neurosurgery. 2011;68(3): 657-673.
16. 16. Nickele C, Nguyen V, Fisher W, et al. A Pilot Comparison of Multispectral Fluorescence to Indocyanine Green Videoangiography and Other Modalities for Intraoperative Assessment in Vascular Neurosurgery. Oper Neurosurg (Hagerstown). 2019;17(1): 103-109.
17. 17. Suzuki K, Kodama N, Sasaki T, et al. Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg. 2003;98(3): 507-514
18. 18. Tajsic T, Cullen J, Guilfoyle M, et al. Indocyanine green fluorescence video angiography reduces vascular injury-related morbidity during micro-neurosurgical clipping of ruptured cerebral aneurysms: a retrospective observational study. Acta Neurochir (Wien). 2019;161(11): 2397-2401.
19. 19. Ozgiray E, Akture E, Patel N, et al. How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration? Clin Neurol Neurosurg. 2013;115(7): 870-878.
20. 20. Washington CW, Zipfel GJ, Chicoine MR, et al. Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery. J Neurosurg. 2013;118(2): 420-427.