Back to Search
Start Over
Microsurgical Clipping of Intracranial Aneurysms Assisted by Neurophysiological Monitoring, Microvascular Flow Probe, and ICG-VA: Outcomes and Intraoperative Data on a Multimodal Strategy
- Source :
- World neurosurgery. 113
- Publication Year :
- 2017
-
Abstract
- The aim of this study is to report data on a multimodal monitoring strategy based on the intraoperative use of neurophysiological monitoring, flowmetry by microflow probe, and intraoperative indocyanine green video angiography (ICG-VA) during microsurgical clipping of intracranial aneurysms.This retrospective analysis was performed on 85 consecutive patients undergoing clipping of 96 intracranial aneurysms with the present monitoring strategy. Patient outcomes were evaluated by assessing rate of aneurysm exclusion and postoperative occurrence of ischemic injury. Intraoperative data for the strategy in addition to changes in each monitoring technique depending on aneurysm features were reported.Complete aneurysm exclusion was achieved in 98.9% of cases. Postoperative symptomatic ischemic injury was recorded in 2.08% aneurysms. Clip repositioning occurred in 40.6% of cases: because of motor evoked potential (MEP) decrease in 9.3%, flowmetry in 22.91%, and ICG-VA in 8.3% of treated aneurysms (1.05% after ICG injection, 7.4% after the squeezing maneuver). The role of each technique differed according to aneurysm features; flowmetry alterations occurred more frequently in distal than in proximal aneurysms (P = 0.0001) and in atherosclerotic aneurysms (P = 0.0001). MEP impairment occurred more often in proximal aneurysms (P0.05). ICG-VA disclosed remnant aneurysms mainly in atherosclerotic aneurysms (P0.05); only one false negative remnant neck was recorded with a negative predictive value of 98.8%.Microsurgical clipping assisted by a multimodal monitoring strategy achieved a high rate of aneurysm exclusion with low morbidity in our series. Our data show that the 3 techniques used in our strategy were complementary and that a monitoring strategy can be tailored to aneurysm features.
- Subjects :
- Indocyanine Green
Male
medicine.medical_specialty
Microsurgery
Intraoperative Neurophysiological Monitoring
medicine.medical_treatment
Video-Assisted Surgery
Aneurysm, Ruptured
Brain Ischemia
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Aneurysm
Postoperative Complications
Medicine
Humans
cardiovascular diseases
Evoked potential
Coloring Agents
Neurophysiological Monitoring
Cerebral Hemorrhage
Retrospective Studies
medicine.diagnostic_test
business.industry
Intracranial Aneurysm
Clipping (medicine)
medicine.disease
Evoked Potentials, Motor
Surgical Instruments
Cerebral Angiography
Microsurgical clipping
chemistry
030220 oncology & carcinogenesis
Cerebrovascular Circulation
Angiography
cardiovascular system
Surgery
Neurology (clinical)
Radiology
business
Rheology
Indocyanine green
Vascular Surgical Procedures
030217 neurology & neurosurgery
Microvascular flow
Subjects
Details
- ISSN :
- 18788769
- Volume :
- 113
- Database :
- OpenAIRE
- Journal :
- World neurosurgery
- Accession number :
- edsair.doi.dedup.....77bd205d6feb2328dd2dc2167a05ee32