The Usefulness of Intraoperative Fluorescence Angiography for the Assessment of Blood Flow in Superior Hypophyseal Artery During Internal Carotid Artery Aneurysm Surgery

Abstract

We evaluated the usefulness of intraoperative fluorescence angiography (FAG) to assess blood flow in the superior hypophyseal artery (SHA) involved in the clipping of the paraclinoidal aneurysm. The SHA of two internal carotid artery (ICA)-SHA aneurysms and one ICA-ophthalmic artery aneurysm were evaluated by fluorescein- or indocyanine green (ICG)-FAG. One SHA was evaluated by the fluorescein-FAG alone, one by fluorescein-FAG and neuroendoscope, and the other by ICG-FAG and visual evoked potential (VEP). Both FAGs provided excellent image quality and high spatial resolution to assess the blood flow in the SHA. The advantage of fluorescein-FAG to ICG-FAG was that the surgeons could observe the fluorescence through the microscope and that the angle of a beam could be optimized to observe the SHA, which was located deeply in the opticocarotid space. The simultaneous usage of FAG and neuroendoscope was useful for the observation of the origin of the SHA that was blind in the ICA-ophthalmic artery aneurysm.
The combination of FAG and VEP was helpful for preserving postoperative visual functions.