Article
Indocyanine green angiography in endoscopic third ventriculostomy
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Authors
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D. Wachter
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen
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T. Behm
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen
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H.C. Ludwig
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen
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V. Rohde
- Abteilung für Neurochirurgie, Georg-August-Universität Göttingen
| Published: | June 4, 2012 |
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Outline
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Objective: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of non-communicating hydrocephalus with a high success rate and relatively low morbidity. Still, injuries to vascular vessels, even with fatal outcome, have been reported and are considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery. So far, any experience with ICG angiography through an endoscope is lacking. We report our initial experience with endoscopic ICG angiography for intraoperative visualization of the basilar artery to reduce the risk of vascular injury in ETV.
Methods: Ten ETVs were performed in ten patients with non-communicating hydrocephalus at our institution. All procedures were done with the aid of a prototype neuroendoscope. After reaching the third ventricle with the endoscope, the translucency of the third ventricular floor and the visibility of the basilar tip were assessed. Then, the ICG modus instead of the white light modus was selected. A double dosage of ICG was infused intravenously. After ICG angiography, ventriculostomy was performed integrating the anatomical information about the vessel localisation.
Results: In all 10 patients ETV as well as ICG angiography was successfully performed. No case of transient or permanent morbidity occurred. In two patients, the course of the basilar artery and its perforating branches could not been clearly seen. Even in the presence of an opaque floor of the third ventricle, ICG angiography clearly demonstrated the course of the basilar artery and its major branches and provided the surgeon with otherwise not retrievable information about the endoscopic vessel anatomy.
Conclusions: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle or in case of re-operations.
