Advertisement

Clipping Cerebral Aneurysm

  • Taku SatoEmail author
  • Kyouichi Suzuki
  • Jun Sakuma
  • Kiyoshi Saito
Chapter
  • 19 Downloads

Abstract

The goal of cerebral aneurysm surgery is the complete occlusion of the aneurysm while preserving the patency of the parent, branching, and perforating arteries. In particular, indocyanine green (ICG) angiography-based near-infrared fluorescence imaging has become more popular in the recent years due to its convenience and accuracy. However, its application has various pitfalls that should be considered.

ICG angiography is an essential intraoperative adjunct in order to observe obstructive cerebral aneurysm by microsurgical clipping and perforating arteries around the cerebral aneurysm.

Dual-image videoangiography , a high-resolution intraoperative imaging system to simultaneously visualize both visible light and near-infrared fluorescence images in ICG angiography, would be a standard microscopic adjunct in microscopic cerebral aneurysm surgeries. In contrast, the combination of all available intraoperative adjuncts complements each other, because of some problems that remain to be solved in ICG angiography.

Keywords

Cerebral aneurysm Perforating artery Indocyanine green angiography Dual-image videoangiography Clipping 

Supplementary material

Video 4.1

We present two cases of aneurysms. Case 1 is a case of right vertebral artery (VA)-posterior inferior cerebral artery (PICA) aneurysm. Dual-image videoangiography (DIVA) simultaneously visualizes both light and near-infrared fluorescence images from Indocyanine green ( ICG) videoangiography. After clipping the aneurysm, DIVA clearly shows the anatomical relation of the occluded aneurysm, the clip, and the lower cranial nerves and also confirms the preservation of blood flow in the VA and PICA. Case 2 is a case of an anterior communicating aneurysm. After clipping an anterior communicating aneurysm, DIVA shows one of two hypothalamic arteries is obliterated by the clip. However, standard ICG angiography shows a patent single hypothalamic artery. Therefore, there is a risk to miss the mistakenly occluded hypothalamic artery. (From https://www.fmu.ac.jp/home/ns/diva_movie/diva.html with permission from Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan) (MOV 2902172 kb)

References

  1. 1.
    Brisman JL, Song JK, Newell DW. Cerebral aneurysms. N Engl J Med. 2006;355:928–39.CrossRefGoogle Scholar
  2. 2.
    Nieuwkamp DJ, Setz LE, Algra A, Linn FH, de Rooij NK, Rinkel GJ. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol. 2009;8:635–42.CrossRefGoogle Scholar
  3. 3.
    Kodama N, Sasaki T, Kawakami M, Sato M, Asari J. Cisternal irrigation therapy with urokinase and ascorbic acid for prevention of vasospasm after aneurysmal subarachnoid hemorrhage. Outcome in 217 patients. Surg Neurol. 2000;53:110–7; discussion 117–8.Google Scholar
  4. 4.
    Sato T, Sasaki T, Sakuma J, Watanabe T, Ichikawa M, Ito E, et al. Quantification of subarachnoid hemorrhage by three-dimensional computed tomography: correlation between hematoma volume and symptomatic vasospasm. Neurol Med Chir (Tokyo). 2011;51:187–94.CrossRefGoogle Scholar
  5. 5.
    Jabbarli R, Bohrer AM, Pierscianek D, Muller D, Wrede KH, Dammann P, et al. The chess score: a simple tool for early prediction of shunt dependency after aneurysmal subarachnoid hemorrhage. Eur J Neurol. 2016;23:912–8.CrossRefGoogle Scholar
  6. 6.
    Korja M, Lehto H, Juvela S. Lifelong rupture risk of intracranial aneurysms depends on risk factors: a prospective finnish cohort study. Stroke. 2014;45:1958–63.CrossRefGoogle Scholar
  7. 7.
    Kotowski M, Naggara O, Darsaut TE, Nolet S, Gevry G, Kouznetsov E, et al. Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011. J Neurol Neurosurg Psychiatry. 2013;84:42–8.CrossRefGoogle Scholar
  8. 8.
    Klopfenstein JD, Spetzler RF, Kim LJ, Feiz-Erfan I, Han PP, Zabramski JM, et al. Comparison of routine and selective use of intraoperative angiography during aneurysm surgery: a prospective assessment. J Neurosurg. 2004;100:230–5.CrossRefGoogle Scholar
  9. 9.
    Tang G, Cawley CM, Dion JE, Barrow DL. Intraoperative angiography during aneurysm surgery: a prospective evaluation of efficacy. J Neurosurg. 2002;96:993–9.CrossRefGoogle Scholar
  10. 10.
    Chiang VL, Gailloud P, Murphy KJ, Rigamonti D, Tamargo RJ. Routine intraoperative angiography during aneurysm surgery. J Neurosurg. 2002;96:988–92.CrossRefGoogle Scholar
  11. 11.
    Stendel R, Pietila T, Al Hassan AA, Schilling A, Brock M. Intraoperative microvascular doppler ultrasonography in cerebral aneurysm surgery. J Neurol Neurosurg Psychiatry. 2000;68:29–35.CrossRefGoogle Scholar
  12. 12.
    Kodama N, Endo Y, Oinuma M, Sakuma J, Suzuki K, Matsumoto M, et al. The principles and pitfalls on using doppler ultrasonography during surgery. No Shinkei Geka. 2005;33:109–17 (in Japanese).Google Scholar
  13. 13.
    Suzuki K, Kodama N, Sasaki T, Matsumoto M, Konno Y, Sakuma J, et al. Intraoperative monitoring of blood flow insufficiency in the anterior choroidal artery during aneurysm surgery. J Neurosurg. 2003;98:507–14.CrossRefGoogle Scholar
  14. 14.
    Horiuchi K, Suzuki K, Sasaki T, Matsumoto M, Sakuma J, Konno Y, et al. Intraoperative monitoring of blood flow insufficiency during surgery of middle cerebral artery aneurysms. J Neurosurg. 2005;103:275–83.CrossRefGoogle Scholar
  15. 15.
    Sasaki T, Itakura T, Suzuki K, Kasuya H, Munakata R, Muramatsu H, et al. Intraoperative monitoring of visual evoked potential: introduction of a clinically useful method. J Neurosurg. 2010;112:273–84.CrossRefGoogle Scholar
  16. 16.
    Raabe A, Nakaji P, Beck J, Kim LJ, Hsu FP, Kamerman JD, et al. Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery. J Neurosurg. 2005;103:982–9.CrossRefGoogle Scholar
  17. 17.
    Suzuki K, Kodama N, Sasaki T, Matsumoto M, Ichikawa T, Munakata R, et al. Confirmation of blood flow in perforating arteries using fluorescein cerebral angiography during aneurysm surgery. J Neurosurg. 2007;107:68–73.CrossRefGoogle Scholar
  18. 18.
    Matano F, Mizunari T, Murai Y, Kubota A, Fujiki Y, Kobayashi S, et al. Quantitative comparison of the intraoperative utility of indocyanine green and fluorescein videoangiographies in cerebrovascular surgery. Oper Neurosurg (Hagerstown). 2017;13:361–6.CrossRefGoogle Scholar
  19. 19.
    Khurana VG, Seow K, Duke D. Intuitiveness, quality and utility of intraoperative fluorescence videoangiography: Australian neurosurgical experience. Br J Neurosurg. 2010;24:163–72.CrossRefGoogle Scholar
  20. 20.
    Killory BD, Nakaji P, Gonzales LF, Ponce FA, Wait SD, Spetzler RF. Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green angiography during cerebral arteriovenous malformation surgery. Neurosurgery. 2009;65:456–62; discussion 462.CrossRefGoogle Scholar
  21. 21.
    Kamp MA, Slotty P, Turowski B, Etminan N, Steiger HJ, Hanggi D, et al. Microscope-integrated quantitative analysis of intraoperative indocyanine green fluorescence angiography for blood flow assessment: First experience in 30 patients. Neurosurgery. 2012;70:65–73; discussion 73–4.Google Scholar
  22. 22.
    Riva M, Amin-Hanjani S, Giussani C, De Witte O, Bruneau M. Indocyanine green videoangiography in aneurysm surgery: systematic review and meta-analysis. Neurosurgery. 2018;83:166–80.CrossRefGoogle Scholar
  23. 23.
    Bruneau M, Appelboom G, Rynkowski M, Van Cutsem N, Mine B, De Witte O. Endoscope-integrated icg technology: first application during intracranial aneurysm surgery. Neurosurg Rev. 2013;36:77–84; discussion 84–5.Google Scholar
  24. 24.
    Nishiyama Y, Kinouchi H, Senbokuya N, Kato T, Kanemaru K, Yoshioka H, et al. Endoscopic indocyanine green video angiography in aneurysm surgery: an innovative method for intraoperative assessment of blood flow in vasculature hidden from microscopic view. J Neurosurg. 2012;117:302–8.CrossRefGoogle Scholar
  25. 25.
    Sato T, Suzuki K, Sakuma J, Takatsu N, Kojima Y, Sugano T, 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. 2015;157:1295–301.Google Scholar
  26. 26.
    Sato T, Bakhit MS, Suzuki K, Sakuma J, Fujii M, Murakami Y, Ito Y, Sure U, Saito K. A novel intraoperative laser light imaging system to simultaneously visualize visible light and near-infrared fluorescence for indocyanine green videoangiography. Cerebrovasc Dis Extra. 2018;8:96–100.CrossRefGoogle Scholar
  27. 27.
    Sato T, Bakhit MS, Suzuki K, Sakuma J, Fujii M, Murakami Y, et al. Utility and safety of a novel surgical microscope laser light source. PLoS One. 2018;13:e0192112.CrossRefGoogle Scholar
  28. 28.
    Sato T, Sakuma J, Suzuki K, Oda K, Kuromi Y, Yamada M, et al. Usefulness of a new high-resolution intraoperative imaging system to simultaneously visualize visible light and near-infrared fluorescence for indocyanine green angiography. Surg Cereb Stroke. 2016;44:362–6. (in Japanese).Google Scholar
  29. 29.
    Sato T, Itakura T, Suzuki K, Sakuma J, Fujii M, Bakhit M, et al. Motor evoked potential monitoring and novel laser light imaging system to simultaneously visualize light and near-infrared fluorescence images in aneurysmal surgery. Surg Cereb Stroke, in press. (in Japanese).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Taku Sato
    • 1
    Email author
  • Kyouichi Suzuki
    • 2
  • Jun Sakuma
    • 1
  • Kiyoshi Saito
    • 1
  1. 1.Department of NeurosurgeryFukushima Medical UniversityFukushimaJapan
  2. 2.Department of NeurosurgeryJapanese Red Cross Fukushima HospitalFukushimaJapan

Personalised recommendations