Article
Near-infrared indocyanine green videoangiography versus microvascular doppler sonography in aneurysm surgery
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Authors
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Gerrit Fischer
- Joachim Oertel Neurochirurgische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
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Axel Stadie
- Joachim Oertel Neurochirurgische Klinik und Poliklinik, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion and restoration of flow in the parent, branching and perforating vessels. In postoperative digital subtraction angiography (DSA), unexpected aneurysm residuals and vessel occlusions are frequently detected. Here the value of two nearly non-invasive and cost-effective techniques for intraoperative flow evaluation (near-infrared indocyanine green video angiography [ICG-VA] and microvascular Doppler sonography [mDs]) is investigated in a prospective study.
Methods: Over a period of ten months the authors surgically clipped 50 aneurysms under intraoperative pre- and post-clipping evaluation of flow in the parent, branching and perforating vessels and the aneurysm sack by the two techniques. Intraoperative applicability of each technique was compared to each other and to postoperative digital subtraction angiography as standard evaluation technique.
Results: Forty-five aneurysms were totally occluded without vessel compromise (90%). Intraoperatively ICG-VA was considered useful in 43 cases (86%) and mDs in 44 cases (88%) respectively. Both techniques could compensate each others weak points to a certain degree; but two branch occlusions (4%) and three neck remnants (6%), were revealed by postoperative DSA.
Conclusions: Both techniques have specific drawbacks that could be compensated by each other to a certain extent. Intraoperatively ICG-VA and mDs should not be considered competitive but complementary. This study implicates that the combination of both applications on a routine basis assures the quality of aneurysm surgery by nearly noninvasive and cost-effective techniques. However, DSA remains the gold standard for evaluation of aneurysm occlusion.
