Vinodh T Doss1, Nitin Goyal2, William Humphries3, Dan Hoit3, Adam Arthur3, Lucas Elijovich4. 1. Department of Neurology, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA. 2. Department of Neurology, University of Tennessee Health Sciences Center., USA. 3. Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA. 4. Department of Neurology, University of Tennessee Health Sciences Center., USA ; Department of Neurosurgery, University of Tennessee Health Sciences Center., USA ; Department of Semmes-Murphey Neurologic and Spine Institute, Memphis, Tenn., USA.
Abstract
BACKGROUND: Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature. OBJECTIVE: We evaluated the correlation between ICG and DSA in clipped intracranial aneurysms. METHODS: A retrospective study of patients who underwent craniotomy and microsurgical clipping of intracranial aneurysms with ICG for 2 years. Patient characteristics, presentation details, operative reports, and pre- and postclipping angiographic images were reviewed to determine the adequacy of the clipping. RESULTS: Forty-seven patients underwent clipping with ICG and postoperative DSA: 57 aneurysms were clipped; 23 patients (48.9%) presented with subarachnoid hemorrhage. Nine aneurysms demonstrated a residual on DSA not identified on ICG (residual sizes ranged from 0.5 to 4.3 mm; average size: 1.8 mm). Postoperative DSA demonstrated no branch occlusions. CONCLUSION: Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. This has important clinical implications with regard to follow-up imaging and surgical/endovascular management.
BACKGROUND: Residual aneurysm after microsurgical clipping carries a risk of aneurysm growth and rupture. Digital subtraction angiography (DSA) remains the standard to determine the adequacy of clipping. Intraoperative indocyanine green (ICG) angiography is increasingly utilized to confirm optimal clip positioning across the neck and to evaluate the adjacent vasculature. OBJECTIVE: We evaluated the correlation between ICG and DSA in clipped intracranial aneurysms. METHODS: A retrospective study of patients who underwent craniotomy and microsurgical clipping of intracranial aneurysms with ICG for 2 years. Patient characteristics, presentation details, operative reports, and pre- and postclipping angiographic images were reviewed to determine the adequacy of the clipping. RESULTS: Forty-seven patients underwent clipping with ICG and postoperative DSA: 57 aneurysms were clipped; 23 patients (48.9%) presented with subarachnoid hemorrhage. Nine aneurysms demonstrated a residual on DSA not identified on ICG (residual sizes ranged from 0.5 to 4.3 mm; average size: 1.8 mm). Postoperative DSA demonstrated no branch occlusions. CONCLUSION: Intraoperative ICG is useful in the clipping of intracranial aneurysms to ensure a gross patency of branch vessels; however, the presence of residual aneurysms and subtle changes in flow in branch vessels is best seen by DSA. This has important clinical implications with regard to follow-up imaging and surgical/endovascular management.
Entities:
Keywords:
Aneurysm clipping; Digital subtraction angiography; Indocyanine green angiography; Intracranial aneurysm; Microsurgical clipping
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