Application of intraoperative indocyanine green videoangiography in microsurgical clipping of ruptured posterior communicating artery aneurysms
10.3760/cma.j.issn.1673-4165.2024.04.005
- VernacularTitle:术中吲哚菁绿视频血管造影在破裂后交通动脉动脉瘤显微外科夹闭术中的应用
- Author:
Lu WANG
1
;
Shiwei YAN
;
Xiguang LIU
;
Aimin LI
Author Information
1. 锦州医科大学，锦州 121000
- Keywords:
Intracranial aneurysm;
Aneurysm, ruptured;
Neurosurgical procedures;
Monitoring, intraoperative;
Indocyanine green;
Cerebral angiography;
Treatment outcome
- From:
International Journal of Cerebrovascular Diseases
2024;32(4):266-271
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the application value of indocyanine green videoangiography (ICG-VA) in microsurgical clipping of ruptured posterior communicating artery aneurysms (PCoAA).Methods:Patients with ruptured PCoAA underwent microsurgical clipping and intraoperative ICG-VA at the Department of Neurosurgery, Lianyungang First People's Hospital from January 2020 to July 2022 were included retrospectively. Head CT was reviewed 3 days after operation to determine perioperative complications. CT angiography (CTA) or digital subtraction angiography (DSA) were used to evaluate the monitoring effect of ICG-VA. Glasgow Outcome Scale (GOS) was used to evaluate the clinical outcomes.Results:Thirty-two patients with ruptured PCoAA (a total of 38 aneurysms) were enrolled, including 7 males (21.9%), aged 57.97±8.91 years (range, 40~73). Twenty-seven patients (84.4%) had single aneurysm and 5 (15.6%) had multiple aneurysms (4 patients with 2 aneurysms and 1 with 3 aneurysms). Twenty-four patients (75.0%) had no or mild consciousness disorder, and 8 (25.0%) had moderate to severe consciousness disorder. The aneurysms of all patients were successfully clipped and ICG-VA was performed for a total of 40 times. Five patients with multiple aneurysms underwent precise localization of the parent artery and aneurysmal body using ICG-VA before clipping. After initial clipping, ICG-VA found 3 cases of residual aneurysms. After adjusting or adding aneurismal clips, ICG-VA showed that the residues were eliminated. Three days after the surgery, CT scan showed that 1 patient had right subdural effusion with periventricular infarction, and 1 had subdural effusion. At the final follow-up, CTA or DSA showed no residual aneurysms; the GOS score of 18 patients (56.3%) were 5, 5 patients (15.6%) were 4, and 9 (28.1%) were 3. There were no cases of vegetative state or death.Conclusion:ICG-VA assisted microsurgical clipping of ruptured PCoAA can effectively avoid residual aneurysms and the clinical application value is significant.
