The Utility and Limitations of Indocyanine Green Video Angiography for Anterior Circulation Aneurysm Surgery

Background: The aim of this study was to analyze the clip repositioning rate and the correlation between indocyanine green angiography (ICGA) and post-operative angiography for completeness of aneurysm occlusion and parent/branching vessel compromise during anterior circulation aneurysm surgery.

Methods: A total of 116 patients with 130 aneurysms who underwent microsurgical clipping of anterior circulation aneurysms and ICGA during surgery from January 2008 to September 2013 were included in this study. Age, gender, aneurysm size, location and rupture status were included in the model for analysis.

Results: In 10 patients (8%), ICGA resulted in clip reposition during surgery. Discordance between ICGA and postoperative angiography was observed in six patients (4%). There was no significant difference of ICGA-postoperative angiography discordance between ruptured and unruptured aneurysms (p = 0.56). On multivariate analysis, patient age, gender, aneurysm size, and rupture status did not reach significance. Ophthalmic ICA aneurysms were more likely to have discordance when compared with all other aneurysms (p = 0.04; OR = 10.8; CI 1.5 - 75.94).

Conclusion: ICGA is a very useful modality for intraoperative assessment of the adequacy of aneurysmal obliteration and patency of parent/ perforating vessels. However, ICGA is not absolutely reliable as a stand alone method during clipping of ophthalmic artery or anterior communicating artery aneurysms and can be complemented with IA. ICGA can be used either as an alternative or complementary to IA during aneurysm surgery.