Ahead of Print: ICGV “False Negatives” Clipped Aneurysms

Screen Shot 2014-04-08 at 2.13.11 PMBackground: Indocyanine Green Video-angiography (ICGV) is becoming routine in intracranial aneurysm surgery, in order to assess intra-operatively both sac obliteration and vessel patency after clipping. However, ICGV-derived data have been reported to be misleading at times. We recently noted that a simple intra-operative maneuver (the “squeezing maneuver”) allows the detection of deceptive ICGV data on aneurysm exclusion and allows potential clip repositioning. The “squeezing maneuver” is based on a gentle pinch of the dome of a clipped aneurysm when ICGV documents its apparent exclusion.

Objective: To present the surgical findings and the clinical outcome of this “squeezing maneuver”.

Methods: Data from 23 consecutive patients affected by intracranial aneurysms who underwent the “squeezing maneuver” were retrospectively analyzed. The clip was repositioned in all cases when the dyeing of the sac was visualized after the maneuver.

Results: In 22% of patients, after an initial ICGV showing the aneurysm exclusion after clipping, the squeezing maneuver caused the prompt dyeing of the sac; in all cases the clip was consequently repositioned. A calcification/atheroma of the wall/neck was predictive of a positive maneuver (p= 0.0002). The aneurysm exclusion rate at post-operative radiological findings was 100%.

Conclusion: With the limits of our small series, the “squeezing maneuver” appears helpful in the intra-operative detection of misleading ICGV data, mostly when dealing with aneurysms with atheromasic and calcified walls.

From: The “Squeezing Maneuver” in Microsurgical Clipping of Intracranial Aneurysms Assisted by Indocyanine Green Video-angiography (ICGV) by Della Puppa et al.

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