title: Dual-Channel Endoscopic Indocyanine Green Fluorescence Angiography for Clipping of Cerebral Aneurysms.
abstract: OBJECTIVE
  Neuroendoscopy is useful for assessing status of perforators, parent arteries, and aneurysms beyond the straight line of microscopic view during aneurysm clipping. We aimed to evaluate the clinical usefulness of our endoscopic indocyanine green angiography (ICGA) system, which can simultaneously display visible light and indocyanine green fluorescent images.
  
  
  METHODS
  Surgical clipping of 16 unruptured aneurysms in 10 patients was performed via the keyhole approach. Using our endoscopic ICGA and commercial microscopic ICGA systems, we prospectively compared 10 targeted cerebral aneurysms at the posterior communicating (n = 4) and anterior choroidal (n = 6) arteries.
  
  
  RESULTS
  Microscopic ICGA and endoscopic ICGA were feasible during surgery. Microscopic ICGA displayed 50% of branch orifices, 100% of branch trunks, and 20% of exact clip positions, whereas endoscopic ICGA showed 100% of these. Based on endoscopic ICGA findings such as incomplete clipping and compromise of parent arteries or branches, clips were repositioned in 2 cases, and additional clips were applied in 2 cases. Complete occlusion and residual neck states were achieved in 6 and 4 aneurysms after surgery. There were no neurologic deficits within 3 months after surgery except for frontalis palsy and anosmia in each patient.
  
  
  CONCLUSIONS
  The endoscopic ICGA system with dual imaging of visible light and indocyanine green fluorescence was very useful for assessing geometry of aneurysms and surrounding vessels before clipping and for evaluating completeness of clip position after clipping.
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. Electronic address: nsdrcho@gmail.com.
authors.forename: Won-Sang
authors.initials: WS
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jeong Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Ha
authors.affiliation: Korea Electrotechnology Research Institute, Russia Science Seoul Center, Seoul, Korea.
authors.forename: Minwoong
authors.initials: M
authors.lastname: Jung
authors.affiliation: Korea Electrotechnology Research Institute, Russia Science Seoul Center, Seoul, Korea.
authors.forename: Choonghee
authors.initials: C
authors.lastname: Lee
authors.affiliation: Korea Electrotechnology Research Institute, Russia Science Seoul Center, Seoul, Korea.
authors.forename: Il Hyung
authors.initials: IH
authors.lastname: Shin
authors.affiliation: Korea Electrotechnology Research Institute, Russia Science Seoul Center, Seoul, Korea.
authors.forename: Uk
authors.initials: U
authors.lastname: Kang
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods*; D005260:Female; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage*; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D044583:Neuroendoscopy / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D013525:Surgical Instruments
chemical_list: D007208:Indocyanine Green
keywords: Cerebral aneurysms; Clipping; Indocyanine green fluorescence; Indocyanine green fluorescence angiography; Neuroendoscope