gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Intraoperative quantitative analysis of ICG video angiography by Flow800 software in 58 patients with intracranial aneurysms

Meeting Abstract

  • M. Hof - Klinik und Poliklinik für allgemeine Neurochirurgie, Universitätsklinikum Köln
  • M. Reiner - Klinik und Poliklinik für allgemeine Neurochirurgie, Universitätsklinikum Köln
  • R. Goldbrunner - Klinik und Poliklinik für allgemeine Neurochirurgie, Universitätsklinikum Köln
  • G. Brinker - Klinik und Poliklinik für allgemeine Neurochirurgie, Universitätsklinikum Köln

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.06.05

DOI: 10.3205/12dgnc336, URN: urn:nbn:de:0183-12dgnc3367

Published: June 4, 2012

© 2012 Hof et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

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Objective: Microscope based ICG video angiography is widely used in the surgical treatment of spinal and cerebral vascular malformations and has become a routine method in many neurosurgical departments. Recently, the additional FLOW 800 module was introduced to allow intraoperative analysis of the time course and intensity of fluorescence. We report here our experiences with this tool regarding the perfusion of vessels and tissue in 58 patients with aneurysms.

Methods: 95 ICG video angiographies were performed in 58 patients with intracranial aneurysm. In the derived image of highest intensity regions of interest (ROI) were defined proximal and distal to the aneurysm in all visible arterial vessels as well as in veins and cortex. By the microscope integrated Flow800-software (Fa. Zeiss, Release 2.21) the time course of fluorescence in the marked ROIs was recorded and displayed as a graph. Time to Peak (TP) of the fluorescence signal in the ROIs was calculated and time intervals between TP in arteries, veins and cortical tissue were defined, resulting in arteriovenous and arteriocortical transit time (avTT and acTT, resp.).

Results: 87 of the recorded 95 ICG video angiographies were of good quality and were used for further analysis. In all cases, quantitative analysis by FLOW800 correlated well with the intraoperative visual impression. Nevertheless, due to the high time resolution of the fluorescence graph analysis even small differences of perfusion time course, not perceivable by visual observation of the ICG video, could be detected. In patients without perfusion deficit avTT was 5.7 s ±1.9 (av. ±SD) and acTT was 1.7 s ±0,6. On the contrary, in two cases with assumed perfusion deficit both values were markedly prolonged. In intraindividually repeated ICG angiographies avTT and acTT were reproducible with only minimal variance (average SD 0,6 and 0,2 resp.).

Conclusions: Intraoperative analysis by FLOW800 module allows the determination of arteriovenous and arteriocortical transit times and is able to detect perfusion deficits early. Therapeutic decision making, up to now based only on visual inspection during ICG video angiography, can therefore be supported by this quantitative analysis.