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Intra-arterial Injection Fluorescein Videoangiography in Aneurysm Surgery

Kuroda, Katsuhiro MD; Kinouchi, Hiroyuki MD, PhD; Kanemaru, Kazuya MD; Nishiyama, Yoshihisa MD, PhD; Ogiwara, Masakazu MD, PhD; Yoshioka, Hideyuki MD, PhD; Horikoshi, Toru MD, PhD

doi: 10.1227/NEU.0b013e3182752f32
Technique Assessment

BACKGROUND: To visualize blood flow in the arteries and aneurysm during surgery, intravenous fluorescence videoangiography has been used. However, the image contrast with this procedure is diminished by repeated study because the dye remains for about 10 minutes after injection.

OBJECTIVE: To determine the optimal dye concentration and to clarify the usefulness of fluorescein videoangiography by intra-arterial dye injection.

METHODS: In the pilot study, fluorescein sodium dissolved at various concentrations was illuminated with excitation light, and fluorescence was detected by cameras. The fluorescence of 0.001% fluorescein sodium solution mixed with plasma at various concentrations was then examined. In 13 aneurysm patients, dye solution was administered through the catheter for intraoperative digital subtraction angiography. The intravenous injection method was also performed, and the findings were compared.

RESULTS: Dye was clinically used at a concentration of 0.005% to 0.1% on the basis of the results of the pilot study. Fluorescence emission from the vessels and aneurysms was clearly observed by both methods; however, arterial injection provided brighter emission, resulting in clearer demonstration of the bloodstream than venous injection. Dye clearance was also quicker, which allowed repeat injections without delay. Dye filling in the aneurysm indicating incomplete occlusion was detected in 2 cases, and occlusion of the perforating artery was observed in 2 cases.

CONCLUSION: Intra-arterial fluorescein videoangiography provides brighter and clearer imaging of blood flow with a smaller dose of dye than intravenous videoangiography. It can be repeated within a short time and is useful for detecting incomplete clipping or unexpected obstruction of arteries.

ABBREVIATIONS: AcomA, anterior communicating artery

DSA, digital subtraction angiography

ICA, internal carotid artery

ICG, indocyanine green

MEP, motor evoked potential

Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan

Correspondence: Hiroyuki Kinouchi, MD, PhD, Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan. E-mail:

Received April 10, 2012

Accepted September 05, 2012

Copyright © by the Congress of Neurological Surgeons