title: The utility and limitations of intraoperative near-infrared indocyanine green videoangiography in aneurysm surgery.
abstract: OBJECTIVE
  To analyze the clip repositioning rate and the correlation between indocyanine green (ICG) videoangiography and conventional postoperative digital subtraction angiography for completeness of aneurysm occlusion and parent and branching vessel compromise.
  
  
  METHODS
  This retrospective study included 112 patients with 126 aneurysms who underwent microsurgical clipping and ICG videoangiography during aneurysm surgery at a single center from January 2008 to June 2013. Age, gender, aneurysm size, location, and rupture status were included in the model for analysis.
  
  
  RESULTS
  In 10 patients (8%), ICG videoangiography resulted in clip repositioning during surgery. Discordance between ICG videoangiography and postoperative angiography was observed in 5 patients (4%). There was no significant difference of ICG videoangiography-postoperative angiography discordance between ruptured and unruptured aneurysms (P = 0.56). On multivariate analysis, patient age, gender, aneurysm size, and rupture status did not reach significance. Ophthalmic internal carotid artery aneurysms were more likely to have discordance compared with all other aneurysms (P = 0.04; odds ratio, 10.8; confidence interval, 1.5-75.94).
  
  
  CONCLUSIONS
  ICG videoangiography is a very useful modality for intraoperative assessment of the adequacy of aneurysmal obliteration and patency of parent and perforating vessels. However, ICG videoangiography is not absolutely reliable as a stand-alone method during clipping of ophthalmic artery aneurysms and can be complemented with intraoperative digital subtraction angiography. ICG videoangiography can be used either as an alternative or as a complementary technique to intraoperative digital subtraction angiography during aneurysm surgery.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Mayur
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Osama
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Menarvia
authors.initials: M
authors.lastname: Nixon
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Abhay
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA.
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Science Center, Shreveport, Louisiana, USA. Electronic address: bguthi@lsuhsc.edu.
authors.forename: Bharat
authors.initials: B
authors.lastname: Guthikonda
mesh_terms: D015901:Angiography, Digital Subtraction / Q000379:methods; D002533:Cerebral Angiography / Q000379:methods*; D004396:Coloring Agents; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D014741:Video Recording / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: Aneurysm; Indocyanine green; Near-infrared; Surgery; Videoangiography