gms | German Medical Science

Objective: For a few years, there is a nearly noninvasive and cost-effective technique for intraoperative blood flow evaluation in aneurysm surgery: the microscope-integrated ICG-VA (mICG-VA). This method provides real-time information about completeness of aneurysm occlusion as well as patency of the involved vessels. Its limitations are seen in the assessment of deep-seated aneurysms, especially in cases of small craniotomies. To compensate these weakpoints, an endoscope with integrated ICG-VA (eICG-VA) was developed. The objective is to assess the clinical value of this method and to compare it to the microscopic version.

Method: Between June 2011 and January 2014, a total of 82 patients with 100 aneurysms were surgically treated using the mICG-VA as well as the eICG-VA. Both methods were performed after clipping in every case. Particular respect was given to the patency of parent, branching and perforating arteries and degree of aneurysm occlusion. Intraoperative applicability of each technique was compared to each other and their results to postoperative digital subtraction angiography (DSA) as standard evaluation technique.

Results: In 69% of the cases, mICG-VA and eICG-VA were equivalent, but in 29% of the cases, eICG-VA provided better results for evaluating the post-clipping situation. Its additional use could prevent one residual aneurysm, two neck remnants and two branch occlusions. Nevertheless, two residual aneurysm fillings and six neck remnants were revealed by postoperative DSA.

Conclusions: The eICG-VA is an improvement, that might increase the quality of aneurysm surgery by providing additional information, especially in cases of deep-seated aneurysms and/or small craniotomies by offering a higher illumination, magnification and an extended viewing angle. Weakpoints of the used model are its great diameter, which limits its introduction into narrow spaces, and the difficult handling of the long endoscope. But further studies are required.