• Justin M Caplan, Eric Sankey, Wuyang Yang, Martin G Radvany, Geoffrey P Colby, Alexander L Coon, Rafael J Tamargo, and Judy Huang.
• *Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; ‡Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; §Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; ¶Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
• Neurosurgery. 2014 Oct 1;75(4):437-43; disucssion 444.

BackgroundIntraoperative angiography (IA) is used to evaluate the adequacy of clip reconstruction of intracranial aneurysms. Alternative imaging such as indocyanine green videoangiography (ICG-VA) has been proposed. The additional benefit of ICG-VA when IA is routinely used has not been previously determined.ObjectiveTo report our experience with the use of ICG-VA in combination with IA vs IA alone.MethodsWe retrospectively reviewed cases of aneurysm clipping during a 21-month period by a single surgeon in which ICG-VA was performed after clip reconstruction prior to IA, or IA alone was performed to verify optimal clipping. Records were reviewed for age, sex, race, length of stay, rupture status, Hunt and Hess grade, aneurysm size, location, and temporary clipping. Intraoperative decision making was determined for each group.ResultsNinety-four patients who underwent 97 craniotomies for 128 aneurysms met inclusion criteria for this study. ICG-VA+IA was performed in 37 craniotomies; IA alone was performed for 60 craniotomies. Baseline characteristics were similar with the exception that median aneurysm size was slightly larger in the ICG-VA group (5.6 mm vs 4.3 mm, P = .04). ICG-VA produced 4 false negatives, which required clip adjustments following IA (10.8%), vs 7 patients (11.7%) in the IA-alone group requiring clip adjustments (P = .897).ConclusionWhen IA is routinely performed, the additional use of ICG-VA does not eliminate the need for post-IA clip adjustments owing to the possibility of false negatives. When ICG-VA suggests optimal clipping, but is followed by IA, the rate of post-IA modifications in this study did not differ significantly than if ICG-VA had not been performed.

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