Abstract
Surgical microscope integrated indocyanine green video angiography (ICG-VA) has been widely used in neurological surgery, especially in cerebrovascular lesions. It has been accepted as a less invasive, simple, real time and repeatable technique. Intra operative imaging is very useful tool in guiding surgery, thus avoiding surgical morbidity. The aim of this review article was to evaluate the efficacy of ICG-VA in cerebrovascular surgery. ICG-VA is a simple method to confirm complete occlusion of the aneurysm lumen and preservation of blood flow in parent, branching, and perforating arteries around the aneurysm. In arterio venous malformation (AVM) surgery, it is useful to detect the residual nidus. It gives exact information about the anastomosis site in extracranial and intracranial artery bypass. It provides information of the plaque location and the patency of the arterial vessel during carotid endarterectomy. Although it gives adequate information during cerebrovascular surgery, it has some limitations. The observation field of ICG-VA is limited under a microscope, making it difficult to confirm the flow in the arteries behind the parent arteries, aneurysm, or thick clot. ICG-VA cannot be relied in deep seated AVMs. The intraoperative information from ICG-VA may be much confirmed with micro vascular Doppler and intra operative DSA in selected cases.
