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KMID : 1001920130530060349
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Journal of Korean Neurosurgical Society
2013 Volume.53 No. 6 p.349 ~ p.355
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Value of Indocyanine Green Videoangiography in Deciding the Completeness of Cerebrovascular Surgery
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Moon Hyung-Sik
Joo Sung-Pil
Seo Bo-Ra
Jang Jae-Won
Kim Jae-Hyoo
Kim Tae-Sun
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Abstract
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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.
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KEYWORD
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Cerebrovascular surgery, Indocyanine green videoangiography, Intraoperative angiography, Patency of graft, Complete obliteration of aneurysm
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