Artikel
Comparison of endoscopic and microscopic ICG-Angiography in elective aneurysm surgery – Introduction of a Semi-automated video data analysis method
Vergleich von endoskopischer und mikroskopischer ICG-Angiographie in der elektiven Aneurysma-Chirurgie: Einführung einer semi-automatischen Videodatenanalyse-Methode
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Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: Despite the recent advancements in endovascular techniques, microsurgical clipping remains an essential treatment modality for intracranial aneurysms. Intraoperative microscopic ICG videoangiography (mICG-VA) evolved into an indispensable technique to confirm complete aneurysm occlusion as well as preserved blood flow in the parent, branching, and perforating arteries. Recent advancements allowed the introduction of endoscope-assisted ICG videoangiography (eICG-VA), with the goal to extend the field of vision. The aim of the present study was to objectively compare endoscope-assisted ICG videoangiography (eICG) with its established microscope counterpart by developing and introducing a novel method for semi-automated video data analysis.
Methods: In this retrospective study, combined endoscopic and microscopic ICG-VA were applied in 24 elective aneurysm clipping procedures (study group) compared to 16 conventionally treated mICG-VA control cases. Video recordings were reviewed to assess the clinical value and consequences of eICG-VA and mICG-VA. The video data was analyzed in a novel computer-assisted process to extract quantified information on ICG intensity inside both the aneurysm and its parent artery. Additionally, statistical analyses were performed to assess baseline characteristics, clinical outcome and number of clips used.
Results: In direct comparison to mICG-VA, eICG-VA provided superior visualization in 32% of cases. The novel, quantitative video data analysis process made it possible to quantify ICG intensity in the aneurysm and a reference artery in both fluorescence techniques. The resulting data suggest that additional clips were unnecessarily applied in three cases, whereas it demonstrated an incomplete aneurysm occlusion in a single case. The application of eICG use resulted in a reduction in the use of clips, with a combined number of implanted + discarded clips of 1.9 ± 1.0 vs. 3. ± 1.8 (Study vs. Control; mean ± SD; p = .027).
Conclusion: We explored a novel semi-automated video data analysis process to quantify cerebrovascular perfusion based on ICG-VA. It provided a different perspective on post-clipping aneurysmatic perfusion in 5 cases, conflicting with and challenging the surgeon’s assessment. In the future, equipment manufacturers could automate and integrate this process into the microscope’s software. This would allow surgeons to take advantage of an intraoperative, quantified perfusion analysis, liberated from the limitations of human perception.
Figure 1 [Fig. 1]