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Indocyanine green fluorescence video angiography reduces vascular injury–related morbidity during micro-neurosurgical clipping of ruptured cerebral aneurysms: a retrospective observational study

Published version
Peer-reviewed

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Authors

Cullen, James 
Guilfoyle, Mathew 
Helmy, Adel 
Kirollos, Ramez 

Abstract

Abstract: Background: Specific procedural complications in aneurysm surgery are broadly related to vascular territory compromise and brain/nerve retraction; vascular complications account for about half of this. Intraoperative indocyanine green video angiography (ICG-VA) provides real-time high spatial resolution imaging of the cerebrovascular architecture, allowing immediate quality assurance of aneurysm occlusion and vessel integrity. The aim of this study was to examine whether the routine use of ICG-VA reduced early procedural complications related to vascular compromise or injury during micro-neurosurgical clipping of ruptured cerebral aneurysms. Methods: Retrospective comparative observational study of 412 adult good-grade (WFNS 1 or 2) SAH patients who had undergone microsurgical clipping without (n = 200, 2001–2004) or with (n = 212, 2009–2015) ICG-VA in a high-volume neurosurgical centre. Results: The ICG-VA group had a significantly lower incidence of procedural vascular complications (7/212; 3.3%) compared with the non-ICG-VA group (19/200; 9.5%) (Fisher’s exact test p = 0.0137). Conclusions: ICG-VA is a straightforward, easy-to-use, intraoperative adjunct which significantly reduces avoidable ‘technical error’ related morbidity.

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Keywords

Original Article - Vascular Neurosurgery - Aneurysm, Vascular Neurosurgery – Aneurysm, Subarachnoid haemorrhage, Cerebral aneurysm, Clipping, Indocyanine green video angiography (ICG-VA)

Journal Title

Acta Neurochirurgica

Conference Name

Journal ISSN

0001-6268
0942-0940

Volume Title

161

Publisher

Springer Vienna