Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian Neurosurgical Experience

Abstract

Introduction: The authors have undertaken a study of their intraoperative experience with indocyanine green fluorescence videoangiography (ICGFV). In particular, the intuitiveness, image quality and clinical utility of this technology have been assessed.

Methods: The records of forty-six consecutive craniotomies utilising ICGFV have been retrospectively reviewed: There were 27 aneurysms, 2 extracranial-intracranial (EC-IC) bypasses, 5 arteriovenous malformations (AVM), 1 dural arteriovenous fistula (DAVF), 3 cavernomas, 5 meningiomas, and 3 gliomas. ICGFV was used in 5 awake-craniotomy patients. ICGFV was performed using a Leica OH4 surgical microscope with integrated near-infrared camera and ICG-PULSION.

Results: All attempts of intraoperative ICGFV were intuitive. Image quality and resolution were excellent. Arterial and venous phases were comparable to digital subtraction angiography (DSA) but field of view was relatively limited. In 12 operations (26%) the surgeon was substantially benefited from ICGFV findings. In 22 operations (48%), ICGFV was useful but did not influence surgical management. ICGFV was of no benefit in 11 operations (24%) and was misleading in 1 (2%). In this series, ICGFV was of benefit to 1 of 11 (9%) patients with an intracranial neoplasm or cavernoma.

Conclusions: ICGFV is safe, intuitive and provides neurosurgeons with high quality, valuable, real-time imaging of cerebrovascular anatomy. It can assist in intraoperative surgical management and/or stroke prevention particularly during aneurysm clipping, EC-IC bypass and AVM/DAVF surgery.

Key words:

• Arteriovenous malformation
• Dural arteriovenous fistula
• Extracranial-intracranial bypass
• Fluorescence videoangiography
• Indocyanine green
• Intracranial aneurysm

Acknowledgements and Declaration of Interests

The contributions by the authors to this paper were as follows: VGK and KS wrote the paper. DD developed this hospital's protocol for intraoperative ICG administration and edited this paper. VGK and KS added the relevant data prospectively to a database. The authors thank Professor Paul Gatenby, Director of Research at The Canberra Hospital for his support. The authors also gratefully acknowledge the assistance of The Canberra Hospital Pharmacy staff and Ms Vicki Gardiner, Ms Kerri Reeves, Ms Rhonda Hosking, Ms Tania Lawrence, and Mr Frank Byrne. There were no sources of funding from grant bodies or Industry in order to undertake this research. The authors duly acknowledge the expert technical assistance of the staff of Leica Microsystems and Medtronic Australasia in optimisation of the equipment and software.