False-negative indocyanine green videoangiography among complex unruptured middle cerebral artery aneurysms: The importance of further aneurysm inspection

Charles Kulwin, Aaron A. Cohen-Gadol

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Successful surgical treatment of cerebral aneurysms requires complete occlusion of the aneurysm lumen while maintaining patency of the adjacent branching and perforating arteries. Intraoperative flow assessment allows aneurysm clip repositioning in the event these requirements are not met, avoiding the risk of postoperative rehemorrhage or infarction. A number of modalities have been proposed for primarily intraoperative qualitative blood flow assessment, including microdoppler ultrasonography, intraoperative digital subtraction angiography (DSA), and more recently noninvasive fluorescent angiography including indocyanine green (ICG) fluorescent imaging. Puncture of the aneurysm dome to exclude aneurysm sac filling may also assess the efficacy of clip placement. Although a high concordance between ICG and DSA has been reported, there remains an important subset of aneurysms for which negative ICG study may erroneously suggest aneurysm occlusion. A high-risk situation for such a false-negative study is an atherosclerotic middle cerebral artery (MCA) aneurysm in which vessel wall plaque interferes with the ICG signal. Furthermore, a decreased flow within the aneurysm may not allow enough emission light for detection under the current technology. In this report, we describe our experience with cases of MCA aneurysms with false-negative ICG-VA studies requiring clip adjustment for optimal surgical treatment and discuss two illustrative cases of MCA aneurysms with intraoperative fluorescence studies that were falsely negative, requiring puncture of the aneurysm to correctly identify incomplete aneurysm occlusion.

Original languageEnglish (US)
Pages (from-to)658-662
Number of pages5
JournalBritish Journal of Neurosurgery
Volume28
Issue number5
DOIs
StatePublished - Oct 2014

Keywords

  • Aneurysm
  • False negative
  • Indocyanine green
  • Microsurgical clipping

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

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