Fluorescein angiography in intracranial aneurysm surgery – a helpful method to evaluate the security of clipping and to observe blood flow

• Published in: World neurosurgery Vol. 105; pp. 406 - 411
• Main Authors: Kakucs, Cristian, M.D., Ph.D. student, Florian, Ioan-Alexandru, M.D, Ungureanu, Gheorghe, M.D, Florian, Ioan-Stefan, M.D., Ph.D., Prof
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2017
• Subjects: Adult; Angiography, Digital Subtraction; Cerebral aneurysm; Cerebral Angiography - methods; Cerebrovascular Circulation - physiology; Female; Fluorescein sodium; Fluorescein videoangiography; Humans; Imaging, Three-Dimensional; Indocyanine Green - metabolism; Intracranial Aneurysm - complications; Male; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - physiopathology; Neurosurgery; Subarachnoid Hemorrhage - diagnostic imaging; Subarachnoid Hemorrhage - etiology; Subarachnoid Hemorrhage - surgery; Surgical Instruments; Tomography Scanners, X-Ray Computed; PCoA; Internal Carotid Artery; Micro Dopler Ultrasonography; FL; Anterior Communicating Artery; ACoA; Indocyanine green; Karnofsky Performance Score; Middle Cerebral Artery; KPS; Videoangiography; Glasgow Coma Score; DSA; Posterior Communicating Artery; fluorescein sodium; fluorescein videoangiography; Subarachnoid Hemorrhage; Hunt and Hess; MDU; Digital subtraction angiography; cerebral aneurysm; ICA; Postero-Inferior Cerebellar Artery; MCA; H&H; VA; ICG; Computed Tomography Angiography; CTA; PICA; GCS; SAH; Cerebral aneurysm; Fluorescein videoangiography; Fluorescein sodium
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.05.172

Abstract Objective In cerebral aneurysm surgery, a number of tools are employed to evaluate blood flow, such as Doppler ultrasonography, conventional cerebral angiography, and electrophysiological monitoring. Fluorescein and indocyanine green are widely used in vascular and central nervous system tumor neurosurgery. Nevertheless, their routine utilization in aneurysmal surgery is uncommon, despite the fact that they allow direct visualization of blood flow after an aneurysmal sac occlusion, enabling the observation of vessel permeability and the effectiveness of aneurysmal obliteration. We report our initial experience using fluorescein videoangiography as a control measure for proper clip placement and control of blood flow in aneurysm surgery and review the relevant literature. Material and methods This pilot study presents an initial experience, having enrolled ten patients harboring a total of 12 cerebral aneurysms that underwent surgery via clipping and subsequent fluorescence videoangiography control. The intravenous injection was performed to demonstrate the patency of the arteries adjacent of the aneurysm. Results Following intravenous injection, fluorescein sodium remains in the cerebral vasculature for around 3 minutes, providing ample time to evaluate the patency of the vessels and whether clip repositioning is necessary. None of the patients presented complications during intravenous injection of fluorescein sodium and the patency of the surrounding vessels was demonstrated in all of the cases. Conclusions Fluorescein injection in itself does not present any risks of complications, it is simple to use and offers a clear image of the cerebral vasculature. Therefore, this method is useful in determining vessel patency and degree of aneurysmal occlusion.