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Prospective Comparison of Intraoperative Vascular Monitoring Technologies during Cerebral Aneurysm Surgery.
MedLine Citation:
PMID:  21164372     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Recently, the non-invasive technique of microscope integrated intraoperative near infrared indocyanine green angiography [ICGA] was developed, allowing assessment of the cerebral vasculature in the operative field after intravenous injection of a fluorescent dye. OBJECTIVE:: To prospectively compare the value of ICGA derived information during cerebral aneurysm surgery with data simultaneously generated from other intraoperative monitoring and vascular imaging techniques. METHODS:: Data from 104 patients with 123 cerebral aneurysms operated on were prospectively recorded. Results of intraoperative vascular monitoring and descriptions of how this information influenced intraoperative decision-making were analysed. RESULTS:: Clip repositioning was necessary in 30 of 123 aneurysms [24.4 %] treated. Parent artery occlusion was documented by microvascular Doppler ultrasound in 4 aneurysms. ICGA disclosed parent artery stenoses that had escaped sonographic detection in 7 cases. Neuroendoscopy was used in 13 cases of midline aneurysms to confirm perforator patency after clipping and disclosed aneurysm misclipping undetected by ICGA and DSA in 1 aneurysm. The information from DSA and ICGA corresponded in 120 of 123 aneurysms operated [97.5 %]. In one patient, ICGA underestimated a relevant parent artery stenosis detected by DSA. In 2 patients with relevant aneurismal misclipping, DSA and ICGA led to conflicting results that could be clarified only when both methods were used and interpreted in conjunction. CONCLUSION:: The intraoperative monitoring and vascular imaging methods compared were complementary rather than competitive in nature. None of the devices used were absolutely reliable when used as a stand-alone method. Correct intraoperative assessment of aneurysm occlusion, perforating artery patency, and parent artery reconstruction was possible in all patients when these techniques were used in conjunction.
Authors:
Andreas Gruber; Christian Dorfer; Harald Standhardt; Gerhard Bavinzski; Engelbert Knosp
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-12-15
Journal Detail:
Title:  Neurosurgery     Volume:  -     ISSN:  1524-4040     ISO Abbreviation:  -     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Medical University of Vienna, Department of Neurosurgery, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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