Comparison of Intraoperative Indocyanine Green Angiography and Digital Subtraction Angiography for Clipping of Intracranial Aneurysms.
BACKGROUND
Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature.


OBJECTIVE
We evaluated the correlation between ICG and DSA in clipped intracranial aneurysms.


METHODS
A retrospective study of patients who underwent craniotomy and microsurgical clipping of intracranial aneurysms with ICG for 2 years. Patient characteristics, presentation details, operative reports, and pre- and postclipping angiographic images were reviewed to determine the adequacy of the clipping.


RESULTS
Forty-seven patients underwent clipping with ICG and postoperative DSA: 57 aneurysms were clipped; 23 patients (48.9%) presented with subarachnoid hemorrhage. Nine aneurysms demonstrated a residual on DSA not identified on ICG (residual sizes ranged from 0.5 to 4.3 mm; average size: 1.8 mm). Postoperative DSA demonstrated no branch occlusions.


CONCLUSIONS
Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. This has important clinical implications with regard to follow-up imaging and surgical/endovascular management.
Department of Neurology, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA.
Vinodh T
VT
Doss
Department of Neurology, University of Tennessee Health Sciences Center., USA.
Nitin
N
Goyal
Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA.
William
W
Humphries
Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA.
Dan
D
Hoit
Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA.
Adam
A
Arthur
Department of Neurology, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA.
Lucas
L
Elijovich
Aneurysm clipping; Digital subtraction angiography; Indocyanine green angiography; Intracranial aneurysm; Microsurgical clipping