title: Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery.
abstract: BACKGROUND
  The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion and restoration of flow in the parent, branching and perforating vessels. In postoperative digital subtraction angiography (DSA), unexpected aneurysm residuals and vessel occlusions are frequently detected. Here, the value of two nearly noninvasive and cost-effective techniques for intraoperative flow evaluation (near-infrared indocyanine green video angiography (ICG-VA) and microvascular Doppler sonography (mDs)) is investigated in a prospective study.
  
  
  METHODS
  Over a period of 10 months, the authors surgically clipped 50 aneurysms under intraoperative pre- and post-clipping evaluation of flow in the parent, branching and perforating vessels and the aneurysm sack by the two techniques. Intraoperative applicability of each technique was compared to each other and to postoperative digital subtraction angiography as standard evaluation technique.
  
  
  RESULTS
  Forty-five aneurysms were totally occluded without vessel compromise (90%). Intraoperatively, ICG-VA was considered useful in 43 cases (86%) and mDs in 44 cases (88%), respectively. Both techniques could compensate each other's weak points to a certain degree; but two branch occlusions (4%) and three neck remnants (6%) were revealed by postoperative DSA.
  
  
  CONCLUSIONS
  Both techniques have specific drawbacks that could be compensated by each other, to a certain extent. Intraoperatively, ICG-VA and mDs should not be considered competitive, but complementary. This study implicates that the combination of both applications on a routine basis assures the quality of aneurysm surgery by nearly noninvasive and cost-effective techniques. However, DSA remains the gold standard for evaluation of aneurysm occlusion.
authors.affiliation: Neurochirurgische Klinik und Poliklinik, Universitaetsmedizin, Johannes Gutenberg-Universitaet, Langenbeckstrasse 1, 55131 Mainz, Germany.
authors.forename: Gerrit
authors.initials: G
authors.lastname: Fischer
authors.forename: Axel
authors.initials: A
authors.lastname: Stadie
authors.forename: Joachim M K
authors.initials: JM
authors.lastname: Oertel
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012886:Skull / Q000098:blood supply*; D019265:Spectroscopy, Near-Infrared / Q000379:methods; D025321:Surgery, Computer-Assisted / Q000379:methods; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D014741:Video Recording / Q000379:methods*
chemical_list: D007208:Indocyanine Green