title: Dual-Image Videoangiography During Intracranial Microvascular Surgery.
abstract: OBJECTIVE
  Indocyanine green videoangiography (ICG-VA) is a valuable tool to assess vessel and aneurysm patency during neurovascular surgical procedures. However, ICG-VA highlights vascular structures, which appear white over a black background. Anatomic relationships are sometimes difficult to understand at first glance. Dual-image videoangiography (DIVA) enables simultaneous visualization of light and near-infrared fluorescence images of ICG-VA.
  
  
  METHODS
  The DIVA system was mounted on an OPMI Pentero Flow 800 intraoperative microscope. DIVA was used during microsurgical procedures on 5 patients who were operated for aneurysm clipping and superficial temporal artery-middle cerebral artery bypass.
  
  
  RESULTS
  DIVA provides real-time simultaneous visualization of aneurysm and vessels and surrounding structures including brain, nerves, and surgical clips. Although visual contrast between vessels and background is higher with standard black-and-white imaging, DIVA makes it easier to understand anatomic relationships between intracranial structures. DIVA also provides better vision of the depth of field.
  
  
  CONCLUSIONS
  DIVA has the potential to become a widely used intraoperative tool to check patency of intracranial vessels. It should be considered as an adjunct to standard ICG-VA for better understanding of vascular anatomy in relation to surrounding structures and can have an impact on decision making during surgery.
authors.affiliation: Department of Neurosciences, Neurosurgery Unit, NOCSAE Modena Hospital, Modena, Italy; Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan. Electronic address: alberto.feletti@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Feletti
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Xiangdong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Riki
authors.initials: R
authors.lastname: Tanaka
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Yamada
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Suyama
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kawase
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D002343:Carotid Artery, Internal / Q000601:surgery; 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; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D061848:Optical Imaging; D014656:Vascular Surgical Procedures / Q000379:methods*; D014711:Vertebral Artery / Q000601:surgery
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
keywords: AVM; Aneurysm; DIVA; Indocyanine green videoangiography; Intraoperative; Patency