Introduction: Near infrared indocyanine green (ICGA) videoangiography is a new technique that allows for real-time evaluation of blood flow in cerebral aneurysms and parent vessels. The aim of this study was to assess the utility, accuracy, and limitations of ICGA in the surgical management of intracranial aneurysms
Methods: All patients with intracranial aneurysms treated by a single surgeon (BG) from 2008-2013 and who underwent ICGA during surgery were included in the study. A prospectively kept database was retrospectively analyzed. Operative summaries, angiograms, and postoperative and ICG videoangiography videos were reviewed. Clip repositioning rate and correlation of ICGA and post-operative angiography for completeness of aneurysm occlusion and parent vessel compromise were analyzed. Discordance between ICG videoangiography and IA was defined as ICG videoangiography demonstrating aneurysm obliteration and normal vessel flow, but postoperative angiogram showing either an aneurysmal remnant and/or vessel occlusion requiring clip repositioning
Results: A total of 112 patients with 126 aneurysms were included in the study. Among these 120 aneurysms were in the anterior circulation and 6 in the posterior circulation. The clip repositioning rate was 8% (n=10). Aneurysm obliteration was observed in 95.2% (n=120) cases and correlated with post-operative angiography in all the cases. On subgroup analysis, the clip repositioning rate and the rate of discordance between ICGA and postoperative angiography was the highest for ophthalmic segment aneurysms (37.5% and 25% respectively). The ICGA-postoperative angiography discordance in patients with ophthalmic segment aneurysms was statistically different (P<0.05). No branch vessel occlusion was noted. There were no complications related to the use of ICGA
Conclusions: These results indicate that although ICGA is an excellent technique for assessing aneurysm obliteration. Its results should be considered with caution in patients with ophthalmic segment internal carotid aneurysms, where intraoperative angiography may be more accurate
Patient Care: the present study aims to identify the limitations of ICGA how to overcome them
Learning Objectives: by the conclusion of this session, participants whould be able to (1) identify the advantages of ICGA and (2) identify the drawbacks and reliability of ICGA