Intraoperative indocyanine green videoangiography (ICG-VA) has been widely used in vascular surgery, where vessels are clearly shown as white on a black background. However, other structures cannot be observed during ICG-VA. We have developed a new, high-resolution intraoperative imaging system (dual-image VA [DIVA]) to simultaneously visualize both light and near-infrared (NIR) fluorescence images from ICG-VA, allowing observation of other structures.
The operative field was illuminated via an operating microscope by halogen and xenon lamps with a filter to eliminate wavelengths over 780 nm. In the camera unit, visible light was filtered to 400–700 nm and NIR fluorescence emission light was filtered to 800–900 nm using a special sensor unit with an optical filter. Light and NIR fluorescence images were simultaneously visualized on a single monitor.
Our system clearly visualized the operative field together with fluorescence-enhanced blood flow. In aneurysm surgeries, we could confirm incomplete clipping with the neck remnant or with remnant flow into the aneurysm. In cases of arteriovenous malformation or arteriovenous fistula, feeding arteries and draining veins were easily distinguished.
This system allows observation of the operative field and enhanced blood flow by ICG together in real time and may facilitate various types of neurovascular surgery.
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This study was supported by grants for the Development of Medical & Welfare Devices in Fukushima Prefecture (24-829).
Conflict of interest
Takatsu and Kojima are employees of Mizuho Corporation. Sugano is an employee of Mitsubishi Electric Engineering Co., Ltd. They have competing financial interests. All remaining authors have declared no conflicts of interest.
Informed consent was obtained from all patients or their legal representatives before enrollment in the study.
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We developed a new high-resolution intraoperative imaging system to simultaneously visualize both the light and near-infrared fluorescence images of indocyanine green angiography. It clearly shows surrounding brain structures and blood flow in the middle cerebral arteries and the aneurysm. After clipping, indocyanine green angiography was performed again. It vividly reveals the anatomical relation of the obliterated aneurysm, clips, preserved blood flow in the middle cerebral arteries, and surrounding brain. Standard indocyanine green angiography shows near-infrared fluorescence image of vessels. It’s hard to realize the anatomical relation of surrounding structures. (MOV 31616 kb)
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Sato, T., Suzuki, K., Sakuma, J. et al. Development of a new high-resolution intraoperative imaging system (dual-image videoangiography, DIVA) to simultaneously visualize light and near-infrared fluorescence images of indocyanine green angiography. Acta Neurochir 157, 1295–1301 (2015). https://doi.org/10.1007/s00701-015-2481-x
- Dual-image videoangiography
- High-resolution microscopic imaging
- Indocyanine green
- Near-infrared fluorescence