Efficacy of Intraoperative Indocyanine Green Angiography in a Neurosurgical Hybrid Operating Suite: A Report of Two Cases

Abstract

Intra-arterial indocyanine green (IA-ICG) angiography is a very useful tool for cerebrospinal vascular surgery, especially for determination of the recipient artery in bypass surgery or identification of vascular malformation. In the present report, we describe two patients whose cerebrospinal vascular disorders were successfully treated with the assistance of intraoperative selective IA-ICG angiography in a neurosurgical hybrid operating suite.

Case 1: A 42-year-old man presented with convulsions. Conventional cerebral angiography demonstrated a giant (32 mm) partially thrombosed aneurysm at the M2-M3 portion of the left middle cerebral artery. Endovascular aneurysm occlusion under superficial temporal artery-middle cerebral artery protection bypass was planned. Superselective IA-ICG angiography was performed via a microcatheter positioned proximal to the aneurysm to select the best candidate for the recipient artery located distal to the aneurysm. The bypass surgery was successfully completed, and endovascular occlusion of the aneurysm was accomplished using detachable coils.

Case 2: A 70-year-old man presented with weakness and bilateral sensory disturbance of the lower extremities caused by recurrence of spinal dural arteriovenous fistula (dAVF). Intraoperative angiography demonstrated that the dAVF was fed by the radicular artery, sharing shunt point at the T10 level, and was drained by the radicular vein. The shunt point and drainer were well visualized by IA-ICG angiography, and direct occlusion of the shunt flow was successfully completed. We discuss the benefit of selective IA-ICG angiography for cerebrospinal vascular surgery in a neurosurgical hybrid operating suite.