Intraoperative indocyanine green angiography in intracranial aneurysm surgery: Microsurgical clipping and revascularization.
BACKGROUND
The goal of this report is to illustrate the use of intraoperative indocyanine green (ICG) angiography in the surgical management of intracranial aneurysms, including microsurgical clipping and revascularization.


METHODS
This study included a series of 45 patients who were surgically treated between June 2007 and May 2008 for intracranial aneurysms. Fourty-three of the patients had anterior circulation aneurysms, and 2 had posterior circulation aneurysms. Forty-one patients were treated with microsurgical clipping. Four patients underwent revascularization combined with aneurysm dissection or trapping. Intraoperative ICG angiography was used to visualize the aneurysm clipping, patency of parent artery or graft. The ICG angiography technique is described, with particular reference to evaluation of the aneurysm clipping and revascularization.


RESULTS
Eighty-nine ICG angiography procedures were performed in 45 patients with intracranial aneurysms. The aneurysms were completely obliterated for all patients, and the grafts were patented for all except 1 patient. Pre-clipping ICG angiography showed the relationship of aneurysm and its parent artery clearly. After aneurysms being clipped, intraoperative ICG angiography found remnant of aneurysms, stenosis or occlusion of parent arteries and grafts in 8 cases, which were revised in the same surgical procedure. The results of ICG angiography correlated well with postoperative DSA in 97% patients.


CONCLUSIONS
ICG angiography can provide real-time information and guide revision in the same surgical procedure for the management of intracranial aneurysms.
Ma
Chi-Yuan
CY
Department of Neurosurery, Nanjing Jinling Hospital, Nanjing University, School of Medicine, 305 East Zhongshan Road, Nanjing 210002, China.
Shi
Ji-Xin
JX
Wang
Han-Dong
HD
Hang
Chun-Hua
CH
Cheng
Hui-Lin
HL
Wu
Wei
W
D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D002548:Cerebral Revascularization / Q000379:methods*; D004396:Coloring Agents; D003399:Craniotomy; D019706:Excitatory Postsynaptic Potentials; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011182:Postoperative Care; D055815:Young Adult
D004396:Coloring Agents; D007208:Indocyanine Green