Value of Indocyanine Green Videoangiography in Deciding the Completeness of Cerebrovascular Surgery.
10.3340/jkns.2013.53.6.349
- Author:
Hyung Sik MOON
1
;
Sung Pil JOO
;
Bo Ra SEO
;
Jae Won JANG
;
Jae Hyoo KIM
;
Tae Sun KIM
Author Information
1. Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea. taesun1963@yahoo.co.kr
- Publication Type:Original Article
- Keywords:
Cerebrovascular surgery;
Indocyanine green videoangiography;
Intraoperative angiography;
Patency of graft;
Complete obliteration of aneurysm
- MeSH:
Aneurysm;
Angiography;
Angiography, Digital Subtraction;
Arteries;
Arteriovenous Malformations;
Endarterectomy, Carotid;
Glycosaminoglycans;
Humans;
Indocyanine Green;
Neck
- From:Journal of Korean Neurosurgical Society
2013;53(6):349-355
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: Recently, microscope-integrated near infrared indocyanine green videoangiography (ICG-VA) has been widely used in cerebrovascular surgery because it provides real-time high resolution images. In our study, we evaluate the efficacy of intraoperative ICG-VA during cerebrovascular surgery. METHODS: Between August 2011 and April 2012, 188 patients with cerebrovascular disease were surgically treated in our institution. We used ICG-VA in that operations with half of recommended dose (0.2 to 0.3 mg/kg). Postoperative digital subtraction angiography and computed tomography angiography was used to confirm anatomical results. RESULTS: Intraoperative ICG-VA demonstrated fully occluded aneurysm sack, no neck remnant, and without vessel compromise in 119 cases (93.7%) of 127 aneurysms. Eight clipping (6.3%) of 127 operations were identified as an incomplete aneurysm occlusion or compromising vessel after ICG-VA. In 41 (97.6%) of 42 patients after carotid endarterectomy, the results were the same as that of postoperative angiography with good patency. One case (5.9%) of 17 bypass surgeries was identified as a nonfunctioning anastomosis after ICG-VA, which could be revised successfully. In the two patients of arteriovenous malformation, ICG-VA was useful for find the superficial nature of the feeding arteries and draining veins. CONCLUSION: ICG-VA is simple and provides real-time information of the patency of vessels including very small perforators within the field of the microscope and has a lower rate of adverse reactions. However, ICG-VA is not a perfect method, and so a combination of monitoring tools assures the quality of cerebrovascular surgery.
