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J Korean Neurosurg Soc. 2013 Jun;53(6):349-55. doi: 10.3340/jkns.2013.53.6.349. Epub 2013 Jun 30.

Value of indocyanine green videoangiography in deciding the completeness of cerebrovascular surgery.

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1
Department of Neurosurgery, Chonnam National University Hospital & Medical School, Gwangju, Korea.

Abstract

OBJECTIVE:

Recently, microscope-integrated near infrared indocyanine green videoangiography (ICG-VA) has been widely used in cerebrovascular surgery because it provides real-time high resolution images. In our study, we evaluate the efficacy of intraoperative ICG-VA during cerebrovascular surgery.

METHODS:

Between August 2011 and April 2012, 188 patients with cerebrovascular disease were surgically treated in our institution. We used ICG-VA in that operations with half of recommended dose (0.2 to 0.3 mg/kg). Postoperative digital subtraction angiography and computed tomography angiography was used to confirm anatomical results.

RESULTS:

Intraoperative ICG-VA demonstrated fully occluded aneurysm sack, no neck remnant, and without vessel compromise in 119 cases (93.7%) of 127 aneurysms. Eight clipping (6.3%) of 127 operations were identified as an incomplete aneurysm occlusion or compromising vessel after ICG-VA. In 41 (97.6%) of 42 patients after carotid endarterectomy, the results were the same as that of postoperative angiography with good patency. One case (5.9%) of 17 bypass surgeries was identified as a nonfunctioning anastomosis after ICG-VA, which could be revised successfully. In the two patients of arteriovenous malformation, ICG-VA was useful for find the superficial nature of the feeding arteries and draining veins.

CONCLUSION:

ICG-VA is simple and provides real-time information of the patency of vessels including very small perforators within the field of the microscope and has a lower rate of adverse reactions. However, ICG-VA is not a perfect method, and so a combination of monitoring tools assures the quality of cerebrovascular surgery.

KEYWORDS:

Cerebrovascular surgery; Complete obliteration of aneurysm; Indocyanine green videoangiography; Intraoperative angiography; Patency of graft

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