Assessment of blood flow in perforating arteries during intracranial aneurysm surgery with intraoperative videoangiography using indocyanine green

THESES

Assessment of blood flow in perforating arteries during intracranial aneurysm surgery with intraoperative videoangiography using indocyanine green (Abstract)^*. Thesis. São Paulo, 2010

Jean Gonçalves de Oliveira^**

INTRODUCTION: Perforating arteries are commonly involved during the surgical dissection and clipping of intracranial aneurysms. Occlusion of perforating arteries may be responsible for ischemic infarction and poor outcome.

OBJECTIVE: The goal of this study was to describe the usefulness of near-infrared indocyanine green videoangiography (ICGA) for the intraoperative assessment of blood flow in perforating arteries that are visible in the surgical field during clipping of intracranial aneurysms. In addition we analyzed the incidence of perforating vessels involved during the aneurysms surgery and the incidence of ischemic infarct caused by compromising of these small arteries.

METHOD: Sixty patients harboring 64 aneurysms were surgically treated and prospectively included in this study. Intraoperative ICGA was performed using a surgical microscope (Carl Zeiss Co. Oberkochen, Germany) with integrated ICGA technology. The presence and involvement of perforating arteries was analyzed in the microsurgical field, during surgical dissection, and during the clip application. Assessment of vascular patency after clipping was also investigated. Only those small arteries that were not visible on preoperative digital subtraction angiography (DSA) were considered for analysis.

RESULTS: In all cases in which perforating vessels were found in the microscope field, the ICGA was able to visualize flow. Among 36 cases whose perforating vessels were visible on ICGA, 11 cases (30.5%) presented a close relation between the aneurysm and perforating arteries. In one patient (9.0%), among these 11 cases with close relation, ICGA showed occlusion of a P1 perforating artery after clip application, which led to immediate correction of the clip confirmed by immediate re-establishment of flow visible with ICGA without clinical consequences. Four patients (6.7%) presented with postoperative perforating artery infarct of whom in 3 patients the perforating arteries were either not visible or distant from the aneurysm.

CONCLUSION: The involvement of perforating arteries during clip application for aneurysm occlusion is a usual finding. Intraoperative ICGA provide visual information with regard to patency of these milimetric vessels, which may avoid their occlusion and further ischemic infarction.

Key words: indocyanine green angiography, infarction, intracranial aneurysm, intraoperative angiography, perforating arteries.

*

Avaliação do fluxo sanguíneo em artérias perfurantes durante a cirurgia de aneurismas intracranianos através da vídeo-angiografia intra-operatória utilizando indocianina verde (Resumo). Tese de Doutorado. Faculdade de Medicina da Universidade de São Paulo (Área de concentração: Ciências/ Medicina/ Neurologia). Orientador: Manoel Jacobsen Teixeira.

Publication Dates

• Publication in this collection
  24 June 2010
• Date of issue
  June 2010