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68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

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Intra-arterial ICG fluorescence video-angiography – a feasible method for intraoperative perfusion assessment?

Meeting Abstract

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  • Eric Jose Suero Molina - Klinik für Neurochirurgie, Universitätsklinikum Münster, Münster, Deutschland
  • Wolfram Schwind - Institut für Klinische Radiologie, Universitätsklinikum Münster, Münster, Deutschland
  • Walter Stummer - Klinik für Neurochirurgie, Universitätsklinikum Münster, Münster, Deutschland
  • Markus Holling - Klinik für Neurochirurgie, Universitätsklinikum Münster, Münster, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.13.03

doi: 10.3205/17dgnc072, urn:nbn:de:0183-17dgnc0723

Published: June 9, 2017

© 2017 Suero Molina et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Indocyanine green (ICG) facilitates the intraoperative visualization of blood vessels and vascular malformations after intravenous injection. ICG fluorescence video-angiography can be used as a tool before and after neurosurgical clipping of aneurysms in order to evaluate cerebral local perfusion and vascular filling. Given the long distance the intravenous ICG bolus arrives diluted, reducing the resolution of images acquired. In the present study we evaluate the usefulness of selective intra-arterial ICG injection during aneurysm surgery and compare it to conventional ICG intravenous angiography.

Methods: Six patients undergoing elective middle cerebral artery aneurysm clipping were assessed. Rise time and transit time after intravenous (5mg ICG) and selective intra-arterial (2.5mg ICG) injections after aneurysms occlusion were compared. DSA was performed intraoperatively. Rise time was defined as the interval between 10% and 90% of the maximum fluorescence signal. Transit time was measured between proximal arteries and adjacent tissue.

Results: After intravenous injections rise time 2.6 +/- 145.1 seconds in the M2-branches, whereas during the selective intra-arterial injection rise time was 418 +/- 92 milliseconds. Rise time in the M2-branches and adjacent parenchyma after intravenous and intra-arterial ICG application was statistically significant (P<0.0001). Transit time between M2-branch and adjacent parenchyma between intravenous and intra-arterial injection was likewise statistically significant (P=0.0002). After intra-arterial injection, pulse-synchronous peaks were recorded and a clearer and detailed vision of parent vessels could be achieved.

Conclusion: Intra-arterial ICG angiography is a feasible method with potential for assessing blood flow and cerebral perfusion during surgery of intracranial aneurysms. It provides information about circulation parameters in parent arteries and adjacent cerebral tissue, being probably more sensitive to acquire perfusion deficits. Though actual analysing tools are not designed to interpret intra-arterial ICG injection, providing the right evaluation software intra-arterial ICG angiography could play a role in the surgery of intracranial aneurysms and arterio-venous malformations.