Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian Neurosurgical Experience.

Introduction: The authors have undertaken a study of their intraoperative experience with indocyanine green fluorescence videoangiography (ICGFV). In particular, the intuitiveness, image quality and clinical utility of this technology have been assessed.

Methods: The records of forty-six consecutive craniotomies utilising ICGFV have been retrospectively reviewed: There were 27 aneurysms, 2 extracranial-intracranial (EC-IC) bypasses, 5 arteriovenous malformations (AVM), 1 dural arteriovenous fistula (DAVF), 3 cavernomas, 5 meningiomas, and 3 gliomas. ICGFV was used in 5 awake-craniotomy patients. ICGFV was performed using a Leica OH4 surgical microscope with integrated near-infrared camera and ICG-PULSION.

Results: All attempts of intraoperative ICGFV were intuitive. Image quality and resolution were excellent. Arterial and venous phases were comparable to digital subtraction angiography (DSA) but field of view was relatively limited. In 12 operations (26%) the surgeon was substantially benefited from ICGFV findings. In 22 operations (48%), ICGFV was useful but did not influence surgical management. ICGFV was of no benefit in 11 operations (24%) and was misleading in 1 (2%). In this series, ICGFV was of benefit to 1 of 11 (9%) patients with an intracranial neoplasm or cavernoma.

Conclusions: ICGFV is safe, intuitive and provides neurosurgeons with high quality, valuable, real-time imaging of cerebrovascular anatomy. It can assist in intraoperative surgical management and/or stroke prevention particularly during aneurysm clipping, EC-IC bypass and AVM/DAVF surgery.