title: The "squeezing maneuver" in microsurgical clipping of intracranial aneurysms assisted by indocyanine green videoangiography.
abstract: BACKGROUND
  Indocyanine green videoangiography (ICGV) is becoming routine in intracranial aneurysm surgery to assess intraoperatively both sac obliteration and vessel patency after clipping. However, ICGV-derived data have been reported to be misleading at times. We recently noted that a simple intraoperative maneuver, the "squeezing maneuver," allows the detection of deceptive ICGV data on aneurysm exclusion and allows potential clip repositioning. The squeezing maneuver is based on a gentle pinch of the dome of a clipped aneurysm when ICGV documents its apparent exclusion.
  
  
  OBJECTIVE
  To present the surgical findings and the clinical outcome of this squeezing maneuver.
  
  
  METHODS
  Data from 23 consecutive patients affected by intracranial aneurysms who underwent the squeezing maneuver were analyzed retrospectively. The clip was repositioned in all cases when the dyeing of the sac was visualized after the maneuver.
  
  
  RESULTS
  In 22% of patients, after an initial ICGV showing the aneurysm exclusion after clipping, the squeezing maneuver caused the prompt dyeing of the sac; in all cases, the clip was consequently repositioned. A calcification/atheroma of the wall/neck was predictive of a positive maneuver (P = .001). The aneurysm exclusion rate at postoperative radiological findings was 100%.
  
  
  CONCLUSIONS
  With the limits of our small series, the squeezing maneuver appears helpful in the intraoperative detection of misleading ICGV data, mostly when dealing with aneurysms with atheromatic and calcified walls.
authors.affiliation: *Department of Neurosurgery and ‡Department of Anaesthesiology, Padua University Hospital, Padua, Italy; §Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.forename: Oriela
authors.initials: O
authors.lastname: Rustemi
authors.forename: Marta
authors.initials: M
authors.lastname: Rossetto
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gioffrè
authors.forename: Marina
authors.initials: M
authors.lastname: Munari
authors.forename: Fady T
authors.initials: FT
authors.lastname: Charbel
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
mesh_terms: D000368:Aged; D002533:Cerebral Angiography; D004396:Coloring Agents; D019781:Corneal Topography; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green