Evaluation of Aneurysmal Clipping by Advanced Microscope-integrated Intraoperative Indocyanine Green Videoangiography

Abstract

OBJECT: The aim of the present study is to assess whether a new technique of surgical microscope-based indocyanine green (ICG) videoangiography (VAG) to assess cortical blood flow is suitable for intraoperative confirmation of successful aneurysm clipping. CASE REPORT: We used a Carl Zeiss Surgical Microscope OPMI^[○!R] Pentero INFRARED 800 and FLOW 800 system (Carl Zeiss Co., Tokyo, Japan), in the case of a 61-year-old woman with an unruptured left middle cerebral artery aneurysm. FLOW 800 is a new tool to analyze video data subsequent its acquisition with ICGVAG. Images were excellent and enabled a real-time surgical assessment if the structures of interest were visible to the surgeon's eye under the microscope, including vessels, perforating arteries, or residual aneurysm neck. Blood flow intensity data were revealed relative to alterations in fluorescence intensity. CONCLUSIONS: ICGVAG and the FLOW 800 system provide simple, reliable, real-time and rapid intraoperative assessment of relative cortical perfusion. This technique may help to improve the quality of neurosurgical procedures.