Indocyanine green fluorescence video angiography – An indispensable tool for avoiding vascular complications during microsurgical clipping of ruptured intracranial aneurysms and improving surgical outcome: A preliminary study

Abstract

Background: The surgical complications in aneurysmal microsurgical clipping are attributable primarily to vascular compromise and retraction injury. The vascular complications almost 50% of these. ICG-VA gives us intraoperative real-time high definition functional imaging of the cerebrovascular tree, thereby allowing immediate quality assessment and control of aneurysm obliteration and parent vessel optimisation. Here we report our preliminary data of an ongoing series of patient study. Objective: This study aims at evaluating the role of ICG VA in avoiding vascular complications during microsurgical clipping of ruptured intracranial aneurysms and ascertaining normative data for ICG dye administration. Materials and Methods: The study aimed at determining the utility of microscope incorporated (Leica M530 OHX microscope) ICG VA in ruptured aneurysm surgery. We used ICG-VA in 17 patients of ruptured aneurysm with WFNS grade 1 and 2 as an adjunct to surgery. We studied multiple patient characteristics, intraoperative ICG peak flow and washout time of dye, and changes made in the operative decisions, and outcome of the surgeries. Results: ICG-VA helped in intraoperative decision making for 5 out of 17 patients. In one patient, inadequate clipping with residual neck was confirmed with ICG-VA and the clip was adjusted. In three patient's perforator/additional vessel compromise was found hence needed clip readjustment, whereas in two patients ICG-VA demonstrated residual filling of large neck sac and 2nd clip was applied in tandem. Conclusion: ICG VA is a conclusively simple adjunctive tool for the early detection and prevention of vascular compromise of multiple vessels and perforators during ruptured aneurysm surgery.