Abstract:
Background: Visualization of cerebral vessels, their branches and the surrounding structures are essential
during cerebrovascular surgery. Indocyanine green dye-based video angiography is a commonly used
technique in cerebrovascular surgery. This paper aims to analyze the real-time imaging of ICG-AG, DIVA,
and the use of ICG-VA with Flow 800 to compare their usefulness in surgery.
Methods: Intraoperative real-time identification of vascular and surrounding structures in twenty nine
anterior circulation aneurysms and three posterior circulation aneurysm clipping, one STA-MCA bypass,
and two carotid endarterectomies were performed in patients using ICG-VA alone, DIVA, ICG-VA with Flow
800 to analyze and compare each of these methods in details.
Results: ICG-VA and DIVA couldn’t visualize perforators in twenty-three cases of cerebral aneurysms clipping
when used alone. Compared to that by adding Flow 800 perforators were easily visualized. In three
cases, occlusion of perforators after clip application was visualized by DIVA and solved by repositioning
surgical clips. In one STA-MCA bypass surgery, adequate blood flow to cortical branches of MCA (M4)
from STA branches was assessed with ICG-VA, DIVA, and the use of ICG-VA with Flow 800 color mapping.
ICG-VA, DIVA, and Flow 800 observed the lack of blood flow and fluttering atherosclerotic plaques in
carotid endarterectomy. In one case of basilar tip aneurysm, we used ICG-VA with Flow 800; the intensity
diagram drawn after determining regions of interest showed that there was no flow within the aneurysm
sac after clipping.
Conclusion: In real-time surgery, a multimodal approach using ICG-VA, DIVA, and ICG-VA with Flow 800
colour mapping can serve as useful tools for better visualization of vascular and surrounding structures.
The benefits of flow 800 color mapping, such as determining regions of interest, intensity diagrams, and
color-coded images, outweigh the advantages over the ICG-VA and DIVA in the visualization of critical vascular
anatomy in humans during surgical procedures.
