gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

A new intraoperative tool in neurosurgery: near-infrared indocyanine green videoangiography

Meeting Abstract

  • corresponding author P. Ferroli - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  • G. Trincali - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  • E. Albanese - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  • A. Miserocchi - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  • M. Broggi - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy
  • G. Broggi - Istituto Nazionale Neurologico Carlo Besta, Milano, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocSO.04.03

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Ferroli et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Vessel visualization and respect of their patency is one of the key points during microneurosurgery. Indocyanine Green (ICG) is a fluorescent dye that is used in ophthalmology to visualize the retinal vessels through the dilated pupils. In the same way, cerebral vessels can be depicted by ICG once exposed through a craniotomy. Good flow visualization provides a reliable and rapid assessment of the patency of vessels of all sizes. Indocyanine green videoangiography may provide helpful information during the surgical treatment of arteriovenous malformations, dural fistulas, bypass surgery, aneurysm clipping and tumor resection.

Methods: In the period between October 2006 and August 2007, the surgical microscope-based (Carl Zeiss - Pentero) ICG-videoangiography was performed during 45 microneurosurgical procedures for tumor resection or treatment of vascular malformations. A microscope-integrated light source containing infrared excitation light illuminated the operating field. The fluorescence (range 780–950 nm, maximum 835 nm) is recorded by a nonintensified video camera. The standard dose of 25 mg of dye is injected intravenously and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the microscope. Arterial, capillary and venous angiographic images can be observed on the video screen in real time and recorded.

Results: In all cases the image quality and resolution provided by ICG-videoangiography enabled a good visualization of blood flow. No side effects due to i.v. ICG were recorded.

Conclusions: Microscope-based ICG videoangiography is a new technology for intraoperative imaging of vascular flow. Its simplicity, speed and high level of accuracy for detecting incompletely clipped aneurysms and inadvertently occluded vessels recommend its use during aneurysm surgery. Visualization of blood flow into the arteries, including small perforating arteries, provided a reliable and useful assessment of their patency in selected cases of tumor resection as well as in bypass procedures.