Indocyanine green angiography in endoscopic third ventriculostomy

Area of Science:

• Neurosurgery
• Medical Imaging
• Vascular Surgery

Background:

• Endoscopic third ventriculostomy (ETV) is a standard treatment for noncommunicating hydrocephalus.
• Vascular injury during ETV is a rare but severe complication.
• Indocyanine green (ICG) angiography is utilized in vascular microneurosurgery.

Purpose of the Study:

• To evaluate the utility of endoscopic ICG angiography during ETV.
• To assess the intraoperative visualization of the basilar artery and its perforators.
• To determine the potential of ICG angiography in reducing vascular injury risks.

Main Methods:

• Eleven patients with noncommunicating hydrocephalus underwent ETV.
• A prototype neuroendoscope was used for ICG angiography before third ventricular floor opening.
• ICG fluorescence was visualized intraoperatively.

Main Results:

• ETV and ICG angiography were successful in 10 out of 11 patients.
• ICG angiography effectively visualized the basilar artery and its branches, even with an opaque third ventricle floor.
• The procedure was deemed useful for identifying critical vascular structures.

Conclusions:

• Endoscopic ICG angiography is a promising adjunct for ETV.
• It enhances visualization of vascular structures, particularly in cases with anatomical variations or reoperations.
• This technique can potentially improve surgical safety by minimizing vascular injury.