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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Changes in local microcirculation during cerebral aneurysm surgery related to the application of indocyanine green

Meeting Abstract

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  • Björn Sommer - Paracelsus-Klinik Osnabrück, Abteilung für Neurochirurgie, Osnabrück, Deutschland
  • Ilker Eyüpoglu - Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
  • Karl Rössler - Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland
  • Hubert Schmitt - Universitätsklinikum Erlangen, Anästhesiologische Klinik, Erlangen, Deutschland
  • Franz-Josef Hans - Paracelsus-Klinik Osnabrück, Abteilung für Neurochirurgie, Osnabrück, Deutschland
  • Michael Buchfelder - Universitätsklinikum Erlangen, Neurochirurgische Klinik, Erlangen, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocP188

doi: 10.3205/18dgnc529, urn:nbn:de:0183-18dgnc5299

Published: June 18, 2018

© 2018 Sommer 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: During microsurgical clipping of cerebral aneurysms, the application of indocyanine green (ICG) angiography gives real-time information on the patency of parent, branching, and perforating arteries. Based on previous observations, we wanted to further investigate how local microcirculation could possibly be affected by ICG.

Methods: Intraoperative continuous monitoring of local cerebral blood flow was performed using the laser-Doppler spectrophotometry system "Oxygen-to-see (O2C)" in 19 consecutive patients (13 female, 6 male; age (mean, 1 SD) 55.9±11.1 yrs) operated on incidental cerebral aneurysms. Post-capillary venous oxygenation (SO2), relative hemoglobin count (rHb), blood cell velocity (velo) and blood flow (flow) were measured in 7-8 mm tissue depth using a subdural probe. Baseline data samples of 30 seconds before i.v. application of ICG were compared to an equivalent data sample immediately before dural closure. Both micro-Doppler ultrasound and ICG angiography were used to assess changes in vessel integrity.

Results: In 18 of 19 patients, a flow increase of 15.9±12.8% was observed, accompanied by an increase of velo of 11.8±10.9% in 11 of 19 patients. The changes in microcirculation lasted 6.5±4.5 minutes until the probe was removed. The other parameters changed according to the ICG’s spectral properties as determined by the NIR spectrophotometry system. One patient (5%) suffered from a postoperative epidural hematoma due to insufficient dural tenting sutures. No neurologic deficits or other complications occurred.

Conclusion: Even minutes after intravenous injection, local cerebral blood flow in the capillary venous system seems to be affected by ICG. If this is just a circumscribed phenomenon or a result of metabolic interaction remains to be determined in laboratory settings. This study was supported by the Johannes und Frieda Marohn-Stiftung (Erlangen, Germany).