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Cortical Indocyanine Green Videography for Quantification of Acute Hypoperfusion After Subarachnoid Hemorrhage: A Feasibility Study

Schubert, Gerrit Alexander MD*; Seiz-Rosenhagen, Marcel MD*; Ortler, Martin MD, MSc*; Czabanka, Marcus MD; Scheufler, Kai-Michael MD*; Thomé, Claudius MD*

doi: 10.1227/NEU.0b013e318265a3fb
Technique Assessment

BACKGROUND: Acute neurological deficits after subarachnoid hemorrhage (SAH) correlate with outcome, and a phase of acute hypoperfusion was characterized recently. Indocyanine green (ICG) videography is an established intraoperative imaging technique with important descriptive potential.

OBJECTIVE: To analyze whether ICG can be used to analyze and confirm perfusion changes early after SAH.

METHODS: We prospectively enrolled 11 patients with acute SAH within the past 24 hours and 14 patients undergoing surgery for unruptured aneurysms. Cortical ICG videography was performed, and offline analysis included the arterial, parenchymal, and venous cortical compartment. Transit times, signal gradient, maximum of fluorescence intensity, and the area under the curve were calculated as surrogate markers for perfusion characteristics.

RESULTS: Arterial, parenchymal, and venous transit times were comparable in both groups. The velocity of signal change in SAH patients was significantly lower in all 3 compartments (P < .001, P < .01, P < .001, respectively), as was the peak fluorescence intensity (P < .001). In SAH patients, fluorescence intensity did not vary between areas with and without diffuse cortical blood. Area under the curve analysis showed significantly lower values in SAH patients compared with the control group (P < .001).

CONCLUSION: Cortical ICG videography and analysis are feasible during surgery. Patients early after SAH have a significantly lower velocity of signal change, lower peak of fluorescence intensity, and lower overall area under the curve, but similar transit times. This technique can be used to quantify perfusion alteration, in this case, acute SAH, and may be used as an adapted measurement tool for intraoperative therapy.

ABBREVIATIONS: AImax, peak fluorescence intensity

AUC, area under the curve

CBF, cerebral blood flow

CBV, cerebral blood volume

HH, Hunt and Hess

ICG, indocyanine green

ICP, intracranial pressure

MAP, mean arterial pressure

mFS, modified Fisher Scale

MTT, mean transit time

ROI, region of interest

TTP, time to peak

*Clinical Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

Department of Neurosurgery, Charité, Universitätsmedizin Berlin, Germany

Correspondence: Gerrit Alexander Schubert, MD, Department of Neurosurgery, Medical University Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. E-mail:

Received January 13, 2012

Accepted June 6, 2012

Copyright © by the Congress of Neurological Surgeons