Institutional members access full text with Ovid®

Impact of Indocyanine Green Videoangiography on Rate of Clip Adjustments Following Intraoperative Angiography

Caplan, Justin M. MD*; Sankey, Eric BS*; Yang, Wuyang MD*; Radvany, Martin G. MD*,‡,§; Colby, Geoffrey P. MD, PhD*,‡,§; Coon, Alexander L. MD*,‡,§; Tamargo, Rafael J. MD*,¶; Huang, Judy MD*

doi: 10.1227/NEU.0000000000000468
Research-Human-Clinical Studies

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 used 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 and Hess grade, aneurysm size, location, and temporary clipping. Intraoperative decision making was determined for each group.

RESULTS: Ninety-four 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 with the exception that median aneurysm size was slightly larger in the ICG-VA group (5.6 mm vs 4.3 mm, P = .04). ICG-VA produced 4 false negatives, which required clip adjustments following IA (10.8%), vs 7 patients (11.7%) in the IA-alone group requiring clip adjustments (P = .897).

CONCLUSION: When IA is routinely performed, the additional use of ICG-VA does not eliminate the need for post-IA clip adjustments owing 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.

ABBREVIATIONS: Acomm, anterior communicating artery

CI, confidence interval

IA, intraoperative angiography

ICG-VA, indocyanine green videoangiography

JHBMC, Johns Hopkins Bayview Medical Center

JHH, Johns Hopkins Hospital

Pcomm, posterior communicating artery

*Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;

Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland;

§Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland;

Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

Correspondence: Judy Huang, MD, Associate Professor of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, 1800 Orleans St, Zayed Tower 6115F, Baltimore, MD 21287. E-mail:

Received January 31, 2014

Accepted June 02, 2014

Copyright © by the Congress of Neurological Surgeons