Background: Intraoperative angiography (IA) is used to evaluate the adequacy of clip reconstruction of intracranial aneurysms. Alternative imaging such as indocyanine green videoangiography (ICG-VA) has been proposed. The additional benefit of ICG-VA when IA is routinely employed has not been previously determined.
Objective: To report our experience with the use of ICG-VA in combination with IA vs. IA alone.
Methods: We retrospectively reviewed cases of aneurysm clipping during a 21-month period by a single-surgeon in which ICG-VA was performed after clip reconstruction prior to IA or IA alone was performed to verify optimal clipping. Records were reviewed for age, sex, race, length of stay, rupture status, Hunt&Hess grade, aneurysm size, location and temporary clipping. Intraoperative decision-making was determined for each group.
Results: 94 patients who underwent 97 craniotomies for 128 aneurysms met inclusion criteria for this study. ICG-VA+IA was performed in 37 craniotomies; IA alone was performed for 60 craniotomies. Baseline characteristics were similar except median aneurysm size was slightly larger in the ICG-VA group (5.6mm vs. 4.3mm,p=.04). ICG-VA produced four false negatives, which required clip adjustments following IA (10.8%) vs. seven patients (11.7%) in the IA alone group requiring clip adjustments (p=0.8973).
Conclusion: When IA is routinely performed, the additional use of ICG-VA does not eliminate the need for post-IA clip adjustments due to the possibility of false-negatives. When ICG-VA suggests optimal clipping, but is followed by IA, the rate of post-IA modifications in this study did not differ significantly than if ICG-VA had not been performed.
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