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Indocyanine Green Angiography in Endoscopic Third Ventriculostomy

Wachter, Dorothee MD; Behm, Timo; von Eckardstein, Kajetan MD; Rohde, Veit MD

doi: 10.1227/NEU.0b013e318285b846
Instrumentation and Technique

BACKGROUND: Endoscopic third ventriculostomy (ETV) has become a well-established method for the treatment of noncommunicating hydrocephalus with a high success rate and a relatively low morbidity rate. However, vessel injury has been repeatedly reported, often with a fatal outcome. Vessel injury is considered to be the most threatening complication. The use of indocyanine green (ICG) angiography has become an established tool in vascular microneurosurgery.

OBJECTIVE: We report our initial experience with endoscopic ICG angiography in ETV for intraoperative visualization of the basilar artery and its perforators to reduce the risk of vascular injury.

METHODS: Eleven patients with noncommunicating hydrocephalus underwent ETV. Before opening of the third ventricular floor, ICG angiography was performed using a prototype neuroendoscope for intraoperative visualization of ICG fluorescence.

RESULTS: In 10 patients, ETV and ICG angiography were successfully performed. In 1 case, ICG angiography failed. Even in the presence of an opaque floor of the third ventricle (n = 5), ICG angiography clearly demonstrated the course of the basilar artery and its major branches and was considered useful.

CONCLUSION: ICG angiography has the potential to become a useful adjunct in ETV for better visualization of vessel structures, especially in the presence of aberrant vasculature, a nontranslucent floor of the third ventricle, or in case of reoperations.

ABBREVIATIONS: ETV, endoscopic third ventriculostomy

ICG, indocyanine green

Department of Neurosurgery, Georg-August-University Göttingen, Göttingen, Germany

Correspondence: Dorothee Wachter, MD, Neurochirurgische Klinik, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, D-37075 Göttingen, Germany. E-mail:

Received July 24, 2012

Accepted January 2, 2013

Copyright © by the Congress of Neurological Surgeons