gms | German Medical Science

Objective: The quality of surgical treatment of intracranial aneurysms is determined by complete aneurysm occlusion while preserving the blood flow in the parent, branching and perforating arteries. Since 2005, there is a nearly noninvasive and cost-effective technique for intraoperative flow evaluation: the microscope-integrated ICG-VA. This method allows real-time information about blood-flow in the aneurysm and the involved vessels, but its limitations are seen in the evaluation of structures located in the depth of the surgical field especially through small craniotomies. To compensate this weak points, an endoscope with integrated ICG-VA was developed. The aim of this study is to assess the use of the new developed method for intraoperative blood flow evaluation and to compare these results to the microscopic versions ones.

Method: Between June 2011 and September 2012, 33 patients with 40 aneurysms were treated surgically with the additional use of the endoscopic-integrated ICG-VA. After Clipping, the evaluation of complete aneurysm occlusion and the flow in the parent, branching and perforating arteries was performed by both methods in every case. Intraoperative applicability of each technique was compared to each other and to postoperative digital subtraction angiography (DSA) as standard evaluation technique.

Results: In 27 cases (67,5%), both methods were equivalent, but in 11 cases (27,5%), the endocopic ICG-VA provided better results for evaluating the post-clipping situation. In four cases (10%), the information given by intraoperative endoscopic ICG-VA significantly changed the surgical procedure and two neck remnants and two branch occlusions could be prevented. Nevertheless, three neck remnants were revealed by postoperative DAS.

Conclusions: The endoscope-integrated ICG-VA is an improvement that might increase the quality of aneurysm surgery by providing additional information. It offers a higher illumination, magnification and an extended viewing angle. Its main advantages are the assessment of deep seated aneurysms especially through small craniotomies but further studies are required.