E-ISSN: 1019-5157
ISSN: 2651-5024
Research
The value of indocyanine green video angiography in surgery of anterior circulation cerebral aneurysms
Huynh Trung-Nghia✉ ,
Nguyen Minh-Anh ,
Bui Hoang-Tuan-Dung ,
Tran Dang-Khoi
DOI: 10.5137/1019-5149.JTN.48876-25.6
Article in Press
Corresponding Author:
Huynh Trung-Nghia (nghia.ht@umc.edu.vn)
Abstract
Aim
Intraoperative assessment is critical in cerebral aneurysm surgery to ensure complete occlusion while preserving adjacent vessels. While digital subtraction angiography (DSA) remains the gold standard, indocyanine green video angiography (ICG-VA) offers real-time imaging with potential advantages in efficiency and accessibility.
Material and Methods
This retrospective study evaluated 131 patients (148 aneurysms) undergoing anterior circulation aneurysm clipping with ICG-VA. Intraoperative ICG-VA findings were compared with postoperative DSA to assess diagnostic accuracy. Primary outcomes included detection of residual aneurysms and vessel compromise.
Results
The technique prompted clip repositioning in 14.2% of cases (21/148 aneurysms). Significant discordance with DSA occurred in wide-necked (23.3%, p<0.001), ophthalmic ICA (20%, p=0.011), and calcified aneurysms (46.1%, p<0.001). Unruptured aneurysms showed seven-fold higher discordance than ruptured cases (11.5% vs 1.6%, p=0.027). ICG-VA demonstrated perfect specificity (100%) but limited sensitivity (8.3%) for residual aneurysm detection.
Conclusion
ICG-VA provides valuable real-time intraoperative assessment with excellent specificity, but its limited sensitivity in complex cases necessitates supplemental DSA for definitive confirmation. The technique should be considered an important adjunct rather than replacement for conventional angiography in aneurysm surgery.
Intraoperative assessment is critical in cerebral aneurysm surgery to ensure complete occlusion while preserving adjacent vessels. While digital subtraction angiography (DSA) remains the gold standard, indocyanine green video angiography (ICG-VA) offers real-time imaging with potential advantages in efficiency and accessibility.
Material and Methods
This retrospective study evaluated 131 patients (148 aneurysms) undergoing anterior circulation aneurysm clipping with ICG-VA. Intraoperative ICG-VA findings were compared with postoperative DSA to assess diagnostic accuracy. Primary outcomes included detection of residual aneurysms and vessel compromise.
Results
The technique prompted clip repositioning in 14.2% of cases (21/148 aneurysms). Significant discordance with DSA occurred in wide-necked (23.3%, p<0.001), ophthalmic ICA (20%, p=0.011), and calcified aneurysms (46.1%, p<0.001). Unruptured aneurysms showed seven-fold higher discordance than ruptured cases (11.5% vs 1.6%, p=0.027). ICG-VA demonstrated perfect specificity (100%) but limited sensitivity (8.3%) for residual aneurysm detection.
Conclusion
ICG-VA provides valuable real-time intraoperative assessment with excellent specificity, but its limited sensitivity in complex cases necessitates supplemental DSA for definitive confirmation. The technique should be considered an important adjunct rather than replacement for conventional angiography in aneurysm surgery.
Keywords
aneurysm
indocyanine green
digital subtraction angiography.