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DOI: 10.1055/s-2004-836223
© Georg Thieme Verlag Stuttgart · New York
Technique and Image Quality of Intraoperative Indocyanine Green Angiography During Aneurysm Surgery Using Surgical Microscope Integrated Near-Infrared Video Technology
Technik und Bildqualität der operationsmikroskop-integrierten Indozyaningrün-VideoangiographiePublication History
Publication Date:
02 March 2005 (online)
![](https://www.thieme-connect.de/media/zblneurochir/200501/lookinside/thumbnails/10.1055-s-2004-836223-1.jpg)
Abstract
Objective: To describe the technical integration of indocyanine green (ICG) near-infrared technology into the optical path of the surgical microscope and to report on the image quality achieved by this method. We hypothesized that ICG angiography permits a simple and quick intraoperative assessment of vessel patency and aneurysm occlusion after clip placement. Methods: A special arrangement of filters was designed to allow the passage of near-infrared light required for the excitation of ICG fluorescence (700-850 nm) from a modified microscope light source into the surgical field and the passage of ICG fluorescence (780-950 nm) from the surgical field back into the optical path of the surgical microscope (Carl Zeiss, Oberkochen, Germany). Thus, ICG angiography could be completely performed with a surgical microscope. 20 patients with intracranial aneurysms were included in the technical evaluation of the new method. Results: Image quality and spatial resolution were excellent and permitted a real-time assessment of vessel patency and aneurysm occlusion if the structures of interest were visible to the surgeon's eye under the microscope, including perforating arteries with a diameter of less than 1 millimeter. In 1 patient, vessel occlusion by the clip was found and in 1 case residual filling of the aneurysm was diagnosed. Both cases could be treated by clip correction within 2 minutes after primary placement of the clip. In all cases, the intraoperative findings correlated with the postoperative digital subtraction angiography. Conclusions: ICG angiography using a surgical microscope is valuable for the intraoperative imaging of arterial and venous flow in all visible vessels including small perforating arteries. The simplicity of the method and the speed with which the investigation can be performed indicate that this technique may help to improve the quality and outcome of surgical procedures and reduce the need for intra- or postoperative angiography in selected cases.
Zusammenfassung
Hintergrund: Es ist Ziel der Arbeit, die technische Integration der Indozyaningrün-Videoangiographie (ICGA) in den optischen Strahlengang des Operationsmikroskopes und die damit erreichte Bildqualität sowie die Handhabung zu beschreiben. Es war unsere Hypothese, dass diese neue Technik eine einfache und rasche intraoperative Kontrolle der Aneurysmaausschaltung und der Gefäßdurchgängigkeit erlaubt. Methoden: Eine spezielle Filteranordnung unter Verwendung von Kantenfiltern ermöglicht die Passage des Anregungslichtes (700-850 nm), das von einer modifizierten Lichtquelle stammt. Gleichzeitig wird die Passage des ICG-Fluoreszenzlichtes (780-950 nm) aus dem Operationsfeld zurück in das OP-Mikroskop (Carl Zeiss, Oberkochen, Germany) erlaubt. Wir berichten über die Ergebnisse der ersten 20 Patienten mit Operation intrakranieller Aneurysmen, die mit der ICGA intraoperativ untersucht wurden. Ergebnisse: Bildqualität und räumliche Auflösung waren sehr gut. Die hohe zeitliche und räumliche Auflösung erlaubte die dynamische Beobachtung der Passage des Kontrastmittels selbst in den kleinsten, sichtbaren Gefäßen einschließlich kleiner kortikaler und perforierender Arterien. Bei 1 Patienten wurde ein unbeabsichtigter Gefäßverschluss durch unmittelbare Korrektur des Clips behoben, bei einem weiteren Patienten wurde ein unvollständiger Aneurysmaverschluss diagnostiziert und der Clip korrigiert. Bei allen Patienten stimmte der postoperative Befund mit der ICGA überein. Zusammenfassung: Die mikroskop-integrierte ICGA stellt eine potenziell wertvolle Methode der intraoperativen vaskulären Bildgebung dar. Die gute räumliche Auflösung und die rasche Durchführung mit der Möglichkeit der Clipkorrektur innerhalb von 2 Minuten können helfen, die Qualität der operativen Aneurysmabehandlung zu verbessern und die Häufigkeit intraoperativer oder postoperativer Angiographien zu senken.
Key words
Intraoperative angiography - flow - indocyanine green - surgical microscope
Schlüsselwörter
Zerebrale Aneurysmen - intraoperative Angiographie - Indozyaningrün
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Andreas RaabeMD, PhD
Department of Neurosurgery · Johann Wolfgang Goethe University Frankfurt am Main
Schleusenweg 2-16
60528 Frankfurt am Main
Germany
Phone: +49/69/63 01 52 95
Fax: +49/69/63 01 71 75
Email: A.Raabe@em.uni-frankfurt.de