For the first time in the State, Intraoperative ICG video-angiography (ICGVA) in Aneurysm Clipping Microneurosurgery was held successfully at the CARE Hospital here.
Microscope integrated ICG video-angiography (ICGVA) is a relatively new technique to check the proper application of clips and blood flow in parent vessels of brain for optimal patient outcome. In this technique a near infra-red (INR) fluorescent dye ICG is injected in a dose of 0.2-0.5mg/kg.
CARE Hospital is the first to introduce successful implementation of ICGVA in the State. This technique mitigates the need of immediate postop angiography and reoperations for clip adjustments for residual aneurysms or parent vessel or perforator vessel occlusion. ICGVA is a tool in the hands of the neurosurgeon not only to establish correct placement of aneurysm clips but also to check excision of nidus of Arterio-venous malformations and check patency of exra-cranial –intra-cranial (EC-IC) bypass. The ultimate goal is increased patient safety in cerebrovascular micro-neurosurgery.
Recently, CARE Hospital used this technique in clipping of an Internal Carotid Bifurcation aneurysm. The patient was a middle-aged woman with Subarachnoid hemorrhage.
Her CT angio brain was suggestive of an ICA bifurcation aneurysm on the right side. She was operated by a right pterional craniotomy and clipping of the aneurysm. After placing the permanent clip, ICGVA was done to check the position of the clip, aneurysm occlusion and parent vessels filling. The hospital has the state- of- the- art neurosurgical microscope with near infrared light source and optical filters for high-resolution fluorescent images, which confirmed complete occlusion of the aneurysm with normal filling of parent vessels. The postoperative course was uneventful and the patient recovered.