PMC4533429_01
Intraoperative photographs before placement of clips on the aneurysm. A: A right transsylvian approach exposed the large aneurysm (AN), M1 segment, and two M2 segments of the middle cerebral artery. B: Intra-arterial ICG and fluorescein videoangiography clearly depicted the aneurysm and the surrounding arteries immediately after the injection. Contrast of image and ability to depict fine arteries were superior in fluorescein to in ICG. Time after the injection is presented in seconds. Flu: fluorescein, ICG: indocyanine green.
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F1
Prior to neck clipping, ICG and fluorescein videoangiography were performed (Fig. 1).
Intraoperative photographs after placement of an additional clip. A: Multiple clips were applied to the aneurysmal neck. B: Intra-arterial ICG and fluorescein videoangiography demonstrated no increase of the dyes in the aneurysmal dome, although the residual filling of the dyes in the aneurysm was observed before the injection. C: Intravenous ICG and fluorescein videoangiography could depict the surrounding arteries clearly; however, the dyes remained in the vessels for more than 5 minutes. Prolonged patchy staining of vessel walls was observed in fluorescein videoangiography (arrow). Also note that the area of fluorescein emission in the aneurysm before intravenous injection (at 0 seconds) was larger than that at 10 seconds after intra-arterial injection (B). Flu: fluorescein, ICG: indocyanine green.
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F2
The additional clip was applied to the aneurysmal neck (Fig. 2A), and no increase of the dyes in the aneurysmal dome was confirmed though the residual filling of the dyes in the aneurysm was still observed before the injection (Fig. 2B). Finally, videoangiography via intravenous injection was performed (Fig. 2C). ICG was not (Fig. 2C, at 0 seconds). Intravenous injection could depict the surrounding arteries clearly; however, contrast of the image of intravenous injection was inferior to that of intra-arterial injection, and the dyes remained in the vessels for more than 5 minutes.