A prospective comparative study of microscope-integrated intraoperative XXXX and indocyanine videoangiography for clip ligation of complex cerebral aneurysms.

@entity1 @entity3194 @entity439 @entity4461 @entity941 @entity432
UNASSIGNED: OBJECT The authors prospectively analyzed 2 microscope-integrated videoangiography techniques using intravenous @entity3194 (ICG) and @entity941 for assessment of cerebral @entity439 and adjacent vessel patency. METHODS The authors prospectively enrolled 22 @entity1 who underwent clip ligation of their @entity439 and used intraoperative videoangiography to assess obliteration of the aneurysmal sac and patency of the adjacent branching and perforating arteries. @entity1 underwent ICG videoangiography (ICG-VA) and the newly developed @entity941 videoangiography (FL-VA) using microscope-integrated fluorescence modules. Two independent observers compared the videoangiography recordings for value and quality to assess @entity439 exclusion and the patency of adjacent arteries. RESULTS All 22 @entity1 first underwent FL-VA and then ICG-VA after clip application. In 7 cases (32%), FL-VA provided superior detail to assess perforating arteries (4 cases), distal branches (2 cases), and both (1 case); such detail was not readily available on ICG-VA. In 1 @entity1 , ICG-VA offered better visualization of posterior communicating @entity432 than FL-VA because of staining artifact on the @entity439 dome from the adjacent tentorium. In 2 @entity1 , FL-VA offered the needed advantage of real-time manipulation of the vessels and flow assessment by visualization through the operating microscope oculars. In 2 other cases, ICG-VA was more practical for repeat usage because of its more efficient clearance from the intravascular space. The ICG-VA image quality was often degraded at higher magnification in deep operative fields, partly due to chromatic aberration. Both ICG-VA and FL-VA afforded restricted views of vasculature based on the angle of surgical approach and obscuration by @entity4461 , @entity439 , or brain tissue. CONCLUSIONS Compared with ICG-VA, FL-VA can potentially provide an improved visualization of vasculature at high magnification in deep surgical fields. ICG-VA is more effective for repeated use during clip repositioning due to ICG's minimal vascular wall extravasation. Therefore, in certain cases, FL-VA may offer some advantages and play a complementary role along with ICG-VA in intraoperative fluorescence evaluation during microsurgical management of @entity439 .
