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Chen SF, Kato Y, Sinha R, Kumar A, Watabe T, Imizu S, Oda J, Oguri D, Sano H, Hirose Y. Surgical treatment of patients with unruptured intracranial aneurysms. J Clin Neurosci 2014; 22:69-72. [PMID: 25443084 DOI: 10.1016/j.jocn.2014.05.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/18/2014] [Accepted: 05/24/2014] [Indexed: 11/29/2022]
Abstract
We present our experience with elective microsurgical clipping of unruptured intracranial aneurysms (UIA) and analyze this management. A total of 150 patients with UIA were reviewed and data were collected with regard to age, sex, presence of symptoms, location and size of the aneurysms, surgical complications and postoperative 1 year outcomes. Aneurysm size was assessed either by three-dimensional CT angiography or digital subtraction angiogram. Glasgow Outcome Scale was used to assess clinical outcomes. One hundred and fifty patients with 165 aneurysms were treated in this series. The mean size of the UIA was 5.6mm. Eighty aneurysms (48.5%) were less than 5mm in size, and 73 (44.2%) were from 5 to 10mm. Ten (6.1%) of the aneurysms were large and two (1.2%) were giant. One hundred and forty-three were asymptomatic and seven were symptomatic before surgery. The outcome was good in 147 patients (98%), and only three patients (2%) had a treatment-related unfavorable outcome. Five patients experienced transient neurological deficits and one patient experienced permanent neurological deficits. Overall 98.7% of the treated aneurysms were satisfactorily obliterated. Wound complications were seen only in three patients. In conclusion, UIA pose a significant challenge for neurosurgeons, where a delicate balance between benefits and possible risks must be weighed. If the requisite expertise is available, they can be treated surgically with low morbidity and a good outcome at specialized neurovascular centers.
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Affiliation(s)
- S F Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Y Kato
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan.
| | - R Sinha
- Department of Neurosurgery, St. Stephen's Hospital, Delhi, India
| | - A Kumar
- Department of Neurosurgery, Nizam's Institute of Medical Science, Hyderabad, India
| | - T Watabe
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - S Imizu
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - J Oda
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - D Oguri
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - H Sano
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
| | - Y Hirose
- Department of Neurosurgery, Fujita Health University Hospital, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
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Takagi K, Oguri D, Kato Y. The outcome of ventriculo-atrial shunt for idiopathic normal pressure hydrocephalus: Analysis of 393 cases. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Oda J, Kato Y, Chen SF, Sodhiya P, Watabe T, Imizu S, Oguri D, Sano H, Hirose Y. Intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery. J Clin Neurosci 2011; 18:1097-100. [PMID: 21715173 DOI: 10.1016/j.jocn.2010.12.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 12/10/2010] [Accepted: 12/13/2010] [Indexed: 02/08/2023]
Abstract
We present our preliminary experience with intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and analysis of blood flow dynamics using fluorescence intensity assessment in cerebral aneurysm clipping surgery. Thirty-nine patients with 43 intracranial aneurysms underwent microsurgical clipping. Intraoperative ICG-VA was performed before and after clip application. An infrared fluorescence module integrated into a surgical microscope was used to visualize fluorescence in the surgical field and we recorded the emitted fluorescent light. An integrated analytical visualization tool simultaneously analyzed the video sequence and converted it into an intensity diagram, which allowed an objective evaluation of the results rather than the subjective assessment of fluorescence using ICG-VA. Overall, ICG-VA was performed 137 times. Incomplete clipping was detected in four patients, which allowed suitable adjustment to completely obliterate the aneurysm. In 12 patients, perforators arising close to, or from, the aneurysmal neck were identified in the surgical field. In three patients, the ICG-VA intensity diagram provided valuable information leading to modification of the primary surgical maneuver. ICG-VA provides high resolution images allowing real-time assessment of the blood flow in the parent artery and arterial branches, including the perforators. The intensity diagram is useful for providing a more objective record of the hemodynamics than the traditional ICG-VA, which relies more on subjective assessment and may allow interobserver variability. We conclude that ICG-VA, combined with the intensity diagram, can reduce the morbidity and complications associated with aneurysm clipping and improve patient outcomes.
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Affiliation(s)
- Jumpei Oda
- Department of Neurosurgery, Fujita Health University Hospital, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan
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Chen SF, Kato Y, Subramanian B, Kumar A, Watabe T, Imizu S, Oda J, Oguri D, Sano H. Retrograde Suction Decompression Assisted Clipping of Large and Giant Cerebral Aneurysms: Our Experience. ACTA ACUST UNITED AC 2011; 54:1-4. [DOI: 10.1055/s-0030-1268479] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chen SF, Kato Y, Oda J, Kumar A, Watabe T, Imizu S, Oguri D, Sano H, Hirose Y. The application of intraoperative near-infrared indocyanine green videoangiography and analysis of fluorescence intensity in cerebrovascular surgery. Surg Neurol Int 2011; 2:42. [PMID: 21541008 PMCID: PMC3075608 DOI: 10.4103/2152-7806.78517] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 02/11/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the usefulness and limitations of the intraoperative near-infrared (NIR) indocyanine green videoangiography (ICG-VA) and analysis of fluorescence intensity in cerebrovascular surgery. METHODS Forty-eight patients received ICG-VA during various surgical procedures from May 2010 to August 2010. Included among them were 45 cases of cerebral aneurysms and 3 cases of cerebral arteriovenous malformations (AVMs). The infrared fluorescence module integrated into the surgical microscope was used to visualize fluorescent areas in the surgical field. An integrated analytical visualization tool constantly analyzed the fluorescence video sequence and generated it in the form of an intensity diagram for objective interpretation. RESULTS Overall, the procedure of ICG VA was done 158 times in 48 patients. There was no adverse effect of ICG dye. In cerebral aneurysm cases, the images obtained were of high resolution. In 4 cases, incomplete clipping was detected by ICG-VA and allowed suitable adjustment to completely obliterate the aneurysm. In 3 aneurysm cases, the intensity diagram of ICG VA provided valuable information. ICG-VA identified the feeding arteries, the draining veins, and nidus in all 3 AVM cases, which was confirmed by an immediate analysis of fluorescence intensity. CONCLUSIONS ICG-VA provides high resolution images allowing real-time assessment of the blood flow in surgical field. The intensity analysis function, in addition, is a useful adjunct to improve the accuracy of the clipping and decrease the complication rates in cerebral aneurysm cases. In cerebral AVM cases, with the help of color map and intensity diagram function, the superficial feeders, drainers, and nidus can be identified easily.
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Affiliation(s)
- S F Chen
- Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
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Imizu S, Kato Y, Sangli A, Oguri D, Sano H. Assessment of Incomplete Clipping of Aneurysms Intraoperatively by a Near-Infrared Indocyanine Green-Video Angiography (Niicg-Va) Integrated Microscope. ACTA ACUST UNITED AC 2008; 51:199-203. [DOI: 10.1055/s-2008-1080916] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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