REVIEW  FLUORESCENCE IN NEUROSURGERY 

Journal of Neurosurgical Sciences 2019 December;63(6):656-60

DOI: 10.23736/S0390-5616.19.04753-2

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

Application of indocyanine green video angiography in vascular neurosurgery

Enrico MARCHESE ¹, Giuseppe M. DELLA PEPA ¹, Giuseppe LA ROCCA ¹ ✉, Alessio ALBANESE ¹, Tamara IUS ², Giorgia A. SIMBOLI ¹, Giovanni SABATINO ¹

¹ Institute of Neurosurgery, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy; ² Unit of Neurosurgery, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy

Indocyanine green video angiography (ICG-VA) is a non-invasive, easy to use and very useful tool for various neurosurgical procedures. The first application was in neurovascular surgery, because it was born as an intravascular tracer for vessels visualization; this has been really useful in aneurysms, atero-venous malformations (AVMs) and dural fistulas surgery where identification, obliteration or patency of vessels is essential. Introduced in vascular neurosurgery since 2003, ICG-VA applications have broadened over time, both in vascular and in other neurosurgical fields. In 2003 Raabe et al. have been the first to describe the use of ICG-VA for intraoperative assessment of cerebral vascular flow, enabling visualization of vessel patency and aneurysm occlusion during aneurysm surgery. ICG-VA applications in vascular neurosurgery have significantly increased over time including complex aneurysms, bypass, atero-venous malformations (AVM) artero-venous fistulas (AVF), evaluation of cortical perfusion. The procedure can be easily repeated after 5-10 minutes. Adverse reactions are comparable to those of other types of contrast media, with frequencies of 0.05% (hypotension, arrhythmia, or, more rarely, anaphylactic shock) to 0.2% (nausea, pruritus, syncope, or skin eruptions. The aim of the present study was to systematically analyze ICG-VA applications in vascular neurosurgery, highlighting the reported advantages and disadvantages, and discussing future perspectives.

KEY WORDS: Aneurysm; Indocyanine green; Arteriovenous malformations