Skip to content
2000
Volume 21, Issue 1
  • ISSN: 1573-4056
  • E-ISSN: 1875-6603
file format pdf download PDF
file format text download EPUB
side by side viewer icon HTML

Abstract

Background

Microsurgical treatment of posterior circulation aneurysms remains challenging due to their deep location, complex anatomical exposure, and close proximity to critical neurovascular structures. Ensuring adequate collateral circulation is paramount for preventing ischemic complications. Indocyanine Green (ICG) and Fluorescein Video Angiography (FL-VAG) have emerged as effective intraoperative tools for assessing cerebral perfusion and guiding surgical decision-making.

Case Presentation

We report the case of a 29-year-old male presenting with a thunderclap headache, nausea, and vomiting, subsequently diagnosed with a fusiform aneurysm at the P2-P3 junction of the left posterior cerebral artery. The patient underwent a subtemporal approach with partial posterior petrosectomy for aneurysm clipping and remodeling. Initially, an STA-P3 and PITA-P3 bypass were considered; however, intraoperative ICG and FL-VAG confirmed sufficient retrograde collateral flow, allowing the bypass procedure to be avoided. Postoperative imaging demonstrated patent circulation in the occipitotemporal region without ischemic compromise.

Conclusion

This case highlights the crucial role of intraoperative fluorescence imaging in refining surgical strategies for complex aneurysm clipping. ICG and FL-VAG enhance surgical precision by providing real-time perfusion assessment, reducing the need for additional vascular interventions, and improving patient outcomes.

© 2025 The Author(s). Published by Bentham Science Publishers.
This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
Loading

Article metrics loading...

/content/journals/cmir/10.2174/0115734056256001250812075213
2025-08-22
2025-12-10

  • From This Site

    /content/journals/cmir/10.2174/0115734056256001250812075213
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

/deliver/fulltext/cmir/21/1/CMIR-21-E15734056256001.html?itemId=/content/journals/cmir/10.2174/0115734056256001250812075213&mimeType=html&fmt=ahah

References

  1. Al-KawazM. ChoS.M. GottesmanR.F. SuarezJ.I. Rivera-LaraL. Impact of cerebral autoregulation monitoring in cerebrovascular disease: A systematic review.Neurocrit. Care20223631053107010.1007/s12028‑022‑01484‑535378665
     [Google Scholar]
  2. BrownR.D.Jr BroderickJ.P. Unruptured intracranial aneurysms: Epidemiology, natural history, management options, and familial screening.Lancet Neurol.201413439340410.1016/S1474‑4422(14)70015‑824646873
     [Google Scholar]
  3. SelviaridisP. SpiliotopoulosA. AntoniadisC. KontopoulosV. ForoglouG. Fusiform aneurysm of the posterior cerebral artery: Report of two cases.Acta Neurochir.2002144329529910.1007/s00701020003911956944
     [Google Scholar]
  4. LawtonMT HamiltonMG MorcosJJ SpetzlerRF Revascularization and aneurysm surgery: Current techniques, indications, and outcome.Neurosurgery1996381839210.1097/00006123‑199601000‑000208747955
     [Google Scholar]
  5. DesaiN.D. MiwaS. KodamaD. KoyamaT. CohenG. PelletierM.P. CohenE.A. ChristakisG.T. GoldmanB.S. FremesS.E. A randomized comparison of intraoperative indocyanine green angiography and transit-time flow measurement to detect technical errors in coronary bypass grafts.J. Thorac. Cardiovasc. Surg.2006132358559410.1016/j.jtcvs.2005.09.06116935114
     [Google Scholar]
  6. EweltC. NemesA. SennerV. WölferJ. BrokinkelB. StummerW. HollingM. Fluorescence in neurosurgery: Its diagnostic and therapeutic use. Review of the literature.J. Photochem. Photobiol. B201514830230910.1016/j.jphotobiol.2015.05.00226000742
     [Google Scholar]
  7. FerroliP. NakajiP. AcerbiF. AlbaneseE. BroggiG. Indocyanine green (ICG) temporary clipping test to assess collateral circulation before venous sacrifice.World Neurosurg.201175112212510.1016/j.wneu.2010.09.01121492675
     [Google Scholar]
  8. FoxI.J. WoodE.H. Indocyanine green: Physical and physiologic properties.Proc. Staff Meet. Mayo Clin.19603573274413701100
     [Google Scholar]
  9. KienzlerJ.C. DiepersM. MarbacherS. RemondaL. FandinoJ. Endovascular temporary balloon occlusion for microsurgical clipping of posterior circulation aneurysms.Brain Sci.202010633410.3390/brainsci1006033432486121
     [Google Scholar]
  10. KimDL Cohen-GadolAA Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions: Technical note.World Neurosurg.2013792404.e1404.e610.1016/j.wneu.2012.07.02822889621
     [Google Scholar]
  11. KumraiT. MaekawaT. ChenY. SugiyamaY. TakagakiM. YamashiroS. TakizawaK. IchinoseT. IshidaF. KishimaH. Deep learning-based fine-grained assessment of aneurysm wall characteristics using 4D-CT angiography.PeerJ202513e1939310.7717/peerj.1939340356666
     [Google Scholar]
  12. RaabeA. NakajiP. BeckJ. KimL.J. HsuF.P.K. KamermanJ.D. SeifertV. SpetzlerR.F. Prospective evaluation of surgical microscope—integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery.J. Neurosurg.2005103698298910.3171/jns.2005.103.6.098216381184
     [Google Scholar]
  13. WashingtonC.W. ZipfelG.J. ChicoineM.R. DerdeynC.P. RichK.M. MoranC.J. CrossD.T. DaceyR.G.Jr Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery.J. Neurosurg.2013118242042710.3171/2012.10.JNS1181823157184
     [Google Scholar]
  14. HardestyD.A. ThindH. ZabramskiJ.M. SpetzlerR.F. NakajiP. Safety, efficacy, and cost of intraoperative indocyanine green angiography compared to intraoperative catheter angiography in cerebral aneurysm surgery.J. Clin. Neurosci.20142181377138210.1016/j.jocn.2014.02.00624736193
     [Google Scholar]
  15. UdaK. TanahashiK. MamiyaT. KanamoriF. YokoyamaK. NishihoriM. IzumiT. ArakiY. SaitoR. Advantages of petrosectomy for superficial temporal artery to superior cerebellar artery bypass based on three-dimensional distance measurements using cadaver heads.Neurosurg. Rev.20224521617162410.1007/s10143‑021‑01686‑z34735687
     [Google Scholar]
  16. CossuG. Le VanT. KerherveL. HouidiS.A. MorlaixE. BonnevilleF. ChaponR. BalandO. CaoC. LleuM. FarahW. El CadhiA. BeaurainJ. PicartT. XuB. BerhoumaM. Enlightening the invisible: Applications, limits and perspectives of intraoperative fluorescence in neurosurgery.Brain and Spine2024410392810.1016/j.bas.2024.10392839823065
     [Google Scholar]
  17. BriguiM. ChauvetD. ClarençonF. DegosV. SourourN.A. NouetA. ClémenceauS. BochA.L. BernatA.L. Di MariaF. CornuP. Recovery from oculomotor nerve palsy due to posterior communicating artery aneurysms: Results after clipping versus coiling in a single-center series.Acta Neurochir.2014156587988410.1007/s00701‑014‑2050‑824610452
     [Google Scholar]
  18. MolyneuxA.J. BirksJ. ClarkeA. SneadeM. KerrR.S.C. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT).Lancet2015385996969169710.1016/S0140‑6736(14)60975‑225465111
     [Google Scholar]
  19. MinhasJ.S. MoullaaliT.J. RinkelG.J.E. AndersonC.S. Blood Pressure management after intracerebral and subarachnoid hemorrhage: The knowns and known unknowns.Stroke20225341065107310.1161/STROKEAHA.121.03613935255708
     [Google Scholar]
  20. RegilloC.D. The present role of indocyanine green angiography in ophthalmology.Curr. Opin. Ophthalmol.199910318919610.1097/00055735‑199906000‑0000710537778
     [Google Scholar]
  21. MolyneuxA.J. KerrR.S.C. YuL.M. ClarkeM. SneadeM. YarnoldJ.A. SandercockP. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: A randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion.Lancet2005366948880981710.1016/S0140‑6736(05)67214‑516139655
     [Google Scholar]
  22. SpetzlerR.F. McDougallC.G. AlbuquerqueF.C. ZabramskiJ.M. HillsN.K. PartoviS. NakajiP. WallaceR.C. The barrow ruptured aneurysm trial: 3-year results.J. Neurosurg.2013119114615710.3171/2013.3.JNS1268323621600
     [Google Scholar]
  23. YanakaK. FujitaK. NoguchiS. MatsumaruY. AsakawaH. AnnoI. MeguroK. NoseT. Intraoperative angiographic assessment of graft patency during extracranial-intracranial bypass procedures.Neurol. Med. Chir.2003431050951310.2176/nmc.43.50914620205
     [Google Scholar]
  24. ZhaoX. BelykhE. CavalloC. ValliD. GandhiS. PreulM.C. VajkoczyP. LawtonM.T. NakajiP. Application of fluorescein fluorescence in vascular neurosurgery.Front. Surg.201965210.3389/fsurg.2019.0005231620443
     [Google Scholar]
  25. WoitzikJ. HornP. VajkoczyP. SchmiedekP. Intraoperative control of extracranial—intracranial bypass patency by near-infrared indocyanine green videoangiography.J. Neurosurg.2005102469269810.3171/jns.2005.102.4.069215871512
     [Google Scholar]
  26. ShahK.J. Cohen-GadolA.A. The application of FLOW 800 ICG videoangiography color maps for neurovascular surgery and intraoperative decision making.World Neurosurg.2019122e186e19710.1016/j.wneu.2018.09.19530292668
     [Google Scholar]
  27. MatanoF. MizunariT. MuraiY. KubotaA. FujikiY. KobayashiS. MoritaA. Quantitative comparison of the intraoperative utility of indocyanine green and fluorescein videoangiographies in cerebrovascular surgery.Oper. Neurosurg.201713336136610.1093/ons/opw02028521359
     [Google Scholar]
  28. NarducciA. OnkenJ. CzabankaM. HechtN. VajkoczyP. Fluorescein videoangiography during extracranial-to-intracranial bypass surgery: Preliminary results.Acta Neurochir.2018160476777410.1007/s00701‑017‑3453‑029307022
     [Google Scholar]
  29. YouW. MengJ. YangX. ZhangJ. JiangG. YanZ. GuF. TaoX. ChenZ. WangZ. ChenG. Microsurgical management of posterior circulation aneurysms: A retrospective study on epidemiology, outcomes, and surgical approaches.Brain Sci.2022128106610.3390/brainsci1208106636009128
     [Google Scholar]
  30. NathalE. Degollado-GarcíaJ. Rodríguez-RubioH.A. Bonilla-SuásteguiA. Serrano-RubioA. Fluorescein videoangiography (FL-VAG) as a predictor of cerebral bypass patency.World Neurosurg. X20242310028710.1016/j.wnsx.2024.10028738516026
     [Google Scholar]
  31. MooreG.E. Fluorescein as an agent in the differentiation of normal and malignant tissues.Science1947106274513013110.1126/science.106.2745.130.b17750790
     [Google Scholar]
  32. MascitelliJ.R. LawtonM.T. HendricksB.K. NakajiP. ZabramskiJ.M. SpetzlerR.F. Analysis of wide-neck aneurysms in the barrow ruptured aneurysm trial.Neurosurgery201985562263110.1093/neuros/nyy43930346618
     [Google Scholar]
/content/journals/cmir/10.2174/0115734056256001250812075213
Loading
Indocyanine Green and Fluorescein Videoangiography for the Assessment of Collateral Circulation in Posterior Circulation Aneurysm Clipping: A Case Report and Review
Curr. Med. Imaging 21, E15734056256001 (2025); https://doi.org/10.2174/0115734056256001250812075213
/content/journals/cmir/10.2174/0115734056256001250812075213
/content/journals/cmir/10.2174/0115734056256001250812075213
Loading

Data & Media loading...


  • Article Type:     Case Report
Keyword(s): Collateral circulation; Fluorescein video angiography; Indocyanine green; Intraoperative imaging; Microsurgical clipping; Posterior circulation aneurysm

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test