Microsurgical clipping of intracranial aneurysms assisted by green indocyanine videoangiography (ICGV) and ultrasonic perivascular microflow probe measurement.

Objectives: The purpose of this work is to assess the surgical and clinical outcome of intracranial aneurysm clipping performed combining the assistance of green indocyanine videoangiography (ICGV) and ultrasonic perivascular microflow probe. Patients and methods: Data from patients affected with intracranial aneurysms who underwent microsurgical clipping assisted by both techniques between May 2012 and April 2013 were retrospectively evaluated. Results: 26 patients with 34 aneurysms (25 unruptured) were enrolled. In a total of 11 aneurysms (32%), the vascular clip needed repositioning, since either the post-clipping microprobe assessment detected a significant flow reduction of the explored vessels (8 cases, 23%) or ICGV identified a residual non-obliterated aneurysm (3 cases, 9%). A second clip repositioning was required in 3 cases (9%) because of dome remnant showed with ICGV. In all cases, final microprobe and ICGV assessments showed a complete exclusion of the aneurysm, without evidence of vascular flow impairment. Postoperatively, 1 patient (3%) presented a residual neck aneurysm. No permanent morbidity was reported. Conclusion: With the limits of our small case series, our results testify that the presented approach may provide high exclusion rate in the treatment of cerebral aneurysm with very low morbidity in selected patients.