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Dual-Image Videoangiography During Intracranial Microvascular Surgery
Alberto Feletti1, Xiangdong Wang2, Riki Tanaka2
1Department of Neurosciences, Neurosurgery Unit, NOCSAE Modena Hospital, Modena, Italy; Department of Neurosurgery, Fujita Health University Hospital, Nagoya, Japan.
World Neurosurgery
|December 28, 2016
Summary
Dual-image videoangiography (DIVA) enhances neurosurgery by simultaneously showing light and fluorescent ICG images. This improves understanding of intracranial vascular anatomy and surgical decision-making during procedures like aneurysm clipping.
Area of Science:
- Neurosurgery
- Medical Imaging
- Vascular Surgery
Background:
- Indocyanine green videoangiography (ICG-VA) is crucial for assessing vessel and aneurysm patency in neurovascular surgery.
- Standard ICG-VA presents vascular structures as white on black, sometimes obscuring complex anatomic relationships.
- Improved visualization is needed for enhanced surgical precision and patient outcomes.
Purpose of the Study:
- To evaluate the utility of Dual-image videoangiography (DIVA) in neurosurgical procedures.
- To assess if DIVA improves the understanding of vascular anatomy compared to standard ICG-VA.
- To determine DIVA's potential impact on intraoperative decision-making.
Main Methods:
- The DIVA system was integrated with an OPMI Pentero Flow 800 intraoperative microscope.
- DIVA was employed during microsurgical procedures on five patients undergoing aneurysm clipping and STA-MCA bypass.
- Simultaneous visualization of light and near-infrared fluorescence ICG images was performed.
Main Results:
- DIVA allowed real-time visualization of aneurysms, vessels, and surrounding structures like brain and nerves.
- While standard imaging offered higher contrast, DIVA facilitated better comprehension of intracranial anatomic relationships.
- Enhanced depth-of-field perception was observed with DIVA.
Conclusions:
- DIVA shows promise as a valuable intraoperative tool for confirming intracranial vessel patency.
- DIVA can serve as an adjunct to standard ICG-VA, improving the understanding of vascular anatomy.
- The enhanced visualization provided by DIVA may positively influence surgical decision-making.
