{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T23:30:54Z","timestamp":1788219054630,"version":"build-2803163510"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2014,2]]},"abstract":"\n Object<\/jats:title>\n Indocyanine green (ICG) videoangiography (VA) in cerebral aneurysm surgery allows confirmation of blood flow in parent, branching, and perforating vessels as well as assessment of remnant aneurysm parts after clip application. A retrospective analysis and review of the literature were conducted to determine the current essential advantages of ICG-VA in aneurysm surgery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n The authors retrospectively evaluated all aneurysm cases treated with the aid of intraoperative ICG-VA at a single institution between 2007 and 2013. They also analyzed the literature published since the initial description of ICG-VA in 2003.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Two hundred forty-six procedures were performed in 232 patients harboring 295 aneurysms. The patients, whose mean age was 54 years, consisted of 159 women and 73 men. One hundred twenty-four surgeries were performed after subarachnoid hemorrhage, and 122 were performed for incidental aneurysms. Single aneurysms were clipped in 185 patients, and multiple aneurysms were clipped in 47 (mean aneurysm diameter 6.9 mm, range 2\u201340 mm). No complications associated with ICG-VA occurred. Intraoperative microvascular Doppler ultrasonography was performed before ICG-VA in all patients, and postoperative digital subtraction angiography (DSA) studies were available in 121 patients (52.2%) for retrospective comparative analysis. In 22 (9%) of 246 procedures, the clip position was modified intraoperatively as a consequence of ICG-VA. Stenosis of the parent vessels (16 procedures) or occlusion of the perforators (6 procedures), not detected by micro-Doppler ultrasonography, were the most common problems demonstrated on ICG-VA. In another 11 procedures (4.5%), residual perfusion of the aneurysm was observed and one or more additional clips were applied. Vessel stenosis or a compromised perforating artery occurred independent of aneurysm location and was about equally common in middle cerebral artery and anterior communicating artery aneurysms. In 2 procedures (0.8%), aneurysm puncture revealed residual blood flow within the lesion, which had not been detected by the ICG-VA. In the postoperative DSA studies, unexpected small (< 2 mm) aneurysm neck remnants, which had not been detected on intraoperative ICG-VA, were found in 11 (9.1%) of 121 patients. However, these remnants remained without consequence except in 1 patient with a 6-mm residual aneurysm dome, which was subsequently embolized with coils.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In a large cohort of consecutive patients, ICG-VA proved to be a helpful intraoperative tool and led to a significant intraoperative clip modification rate of 15%. However, small, < 2-mm-wide neck remnants and a 6-mm residual aneurysm were missed by intraoperative ICG-VA in up to 10% of patients. Results in this study confirm that DSA is indispensable for postoperative quality assessment in complex aneurysm surgery.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2013.11.focus13475","type":"journal-article","created":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T03:36:45Z","timestamp":1391225805000},"page":"E7","source":"Crossref","is-referenced-by-count":95,"title":["Essentials in intraoperative indocyanine green videoangiography assessment for intracranial aneurysm surgery: conclusions from 295 consecutively clipped aneurysms and review of the literature"],"prefix":"10.3171","volume":"36","author":[{"given":"Karl","family":"Roessler","sequence":"first","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Krawagna","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnd","family":"D\u00f6rfler","sequence":"additional","affiliation":[{"name":"Neuroradiology, University Hospital Erlangen-Nuremberg, Erlangen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Buchfelder","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Ganslandt","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0360007","series-title":"Surg Neurol","first-page":"543","article-title":"Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience","volume":"71","author":"Dashti","year":"2009"},{"key":"b2-0360007","series-title":"J Neurosurg","first-page":"396","article-title":"Late angiographic follow-up review of surgically treated aneurysms","volume":"91","author":"David","year":"1999"},{"key":"b3-0360007","series-title":"Can Med Assoc J","first-page":"1","article-title":"Intracarotid fluorescein angiography: a new method for examination of the epicerebral circulation in man","volume":"96","author":"Feindel","year":"1967"},{"key":"b4-0360007","series-title":"J Neurosurg","first-page":"30","article-title":"Natural history of postoperative aneurysm rests","volume":"66","author":"Feuerberg","year":"1987"},{"key":"b5-0360007","series-title":"Acta Neurochir (Wien)","first-page":"1519","article-title":"Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery","volume":"152","author":"Fischer","year":"2010"},{"key":"b6-0360007","series-title":"AJNR Am J Neuroradiol","first-page":"E36","article-title":"Superselective indocyanine green angiography for selective revascularization in the management of peripheral cerebral aneurysms","volume":"33","author":"Gruber","year":"2012"},{"key":"b7-0360007","series-title":"Neurosurgery","first-page":"657","article-title":"Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery","volume":"68","author":"Gruber","year":"2011"},{"key":"b8-0360007","series-title":"Minim Invasive Neurosurg","first-page":"199","article-title":"Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope","volume":"51","author":"Imizu","year":"2008"},{"key":"b9-0360007","series-title":"J Clin Neurosci","first-page":"26","article-title":"Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique","volume":"17","author":"Jing","year":"2010"},{"key":"b10-0360007","series-title":"World Neurosurg","first-page":"404.e1","article-title":"Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions: technical note","volume":"79","author":"Kim","year":"2013"},{"key":"b11-0360007","series-title":"Neurol India","first-page":"453","article-title":"Assessment of microscope-integrated indocyanine green angiography during intracranial aneurysm surgery: a retrospective study of 120 patients","volume":"57","author":"Li","year":"2009"},{"key":"b12-0360007","series-title":"Clin Neurol Neurosurg","first-page":"840","article-title":"Intraoperative indocyanine green angiography in intracranial aneurysm surgery: Microsurgical clipping and revascularization","volume":"111","author":"Ma","year":"2009"},{"key":"b13-0360007","series-title":"J Neurosurg","first-page":"526","article-title":"Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations","volume":"73","author":"Martin","year":"1990"},{"key":"b14-0360007","series-title":"J Korean Neurosurg Soc","first-page":"349","article-title":"Value of indocyanine green videoangiography in deciding the completeness of cerebrovascular surgery","volume":"53","author":"Moon","year":"2013"},{"key":"b15-0360007","series-title":"World Neurosurg","first-page":"477.e7","article-title":"Intraoperative Matas test using microscope-integrated intraoperative indocyanine green videoangiography with temporary unilateral occlusion of the A1 segment of the anterior cerebral artery","volume":"76","author":"Murai","year":"2011"},{"key":"b16-0360007","series-title":"J Clin Neurosci","first-page":"1097","article-title":"Intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery","volume":"18","author":"Oda","year":"2011"},{"key":"b17-0360007","series-title":"Clin Neurol Neurosurg","first-page":"870","article-title":"How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration?","volume":"115","author":"\u00d6zgiray","year":"2013"},{"key":"b18-0360007","series-title":"Neurosurgery","first-page":"132","article-title":"Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow","volume":"52","author":"Raabe","year":"2003"},{"key":"b19-0360007","series-title":"Zentralbl Neurochir","first-page":"1","article-title":"Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology","volume":"66","author":"Raabe","year":"2005"},{"key":"b20-0360007","series-title":"J Neurosurg","first-page":"982","article-title":"Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"103","author":"Raabe","year":"2005"},{"key":"b21-0360007","series-title":"Acta Neurochir (Wien)","first-page":"1153","article-title":"Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms)","volume":"140","author":"Sindou","year":"1998"},{"key":"b22-0360007","series-title":"Neurosurg Rev","first-page":"209","article-title":"Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"34","author":"Wang","year":"2010"},{"key":"b23-0360007","series-title":"J Neurosurg","first-page":"420","article-title":"Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery. Clinical article","volume":"118","author":"Washington","year":"2013"},{"key":"b24-0360007","series-title":"Neurosurgery","first-page":"970","article-title":"Intraoperative assessment of aneurysm clip placement by intravenous fluorescein angiography","volume":"35","author":"Wrobel","year":"1994"},{"key":"b1-0360007","series-title":"Surg Neurol","first-page":"543","article-title":"Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience","volume":"71","author":"Dashti","year":"2009"},{"key":"b2-0360007","series-title":"J Neurosurg","first-page":"396","article-title":"Late angiographic follow-up review of surgically treated aneurysms","volume":"91","author":"David","year":"1999"},{"key":"b3-0360007","series-title":"Can Med Assoc J","first-page":"1","article-title":"Intracarotid fluorescein angiography: a new method for examination of the epicerebral circulation in man","volume":"96","author":"Feindel","year":"1967"},{"key":"b4-0360007","series-title":"J Neurosurg","first-page":"30","article-title":"Natural history of postoperative aneurysm rests","volume":"66","author":"Feuerberg","year":"1987"},{"key":"b5-0360007","series-title":"Acta Neurochir (Wien)","first-page":"1519","article-title":"Near-infrared indocyanine green videoangiography versus microvascular Doppler sonography in aneurysm surgery","volume":"152","author":"Fischer","year":"2010"},{"key":"b6-0360007","series-title":"AJNR Am J Neuroradiol","first-page":"E36","article-title":"Superselective indocyanine green angiography for selective revascularization in the management of peripheral cerebral aneurysms","volume":"33","author":"Gruber","year":"2012"},{"key":"b7-0360007","series-title":"Neurosurgery","first-page":"657","article-title":"Prospective comparison of intraoperative vascular monitoring technologies during cerebral aneurysm surgery","volume":"68","author":"Gruber","year":"2011"},{"key":"b8-0360007","series-title":"Minim Invasive Neurosurg","first-page":"199","article-title":"Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope","volume":"51","author":"Imizu","year":"2008"},{"key":"b9-0360007","series-title":"J Clin Neurosci","first-page":"26","article-title":"Intraoperative assessment of anterior circulation aneurysms using the indocyanine green video angiography technique","volume":"17","author":"Jing","year":"2010"},{"key":"b10-0360007","series-title":"World Neurosurg","first-page":"404.e1","article-title":"Indocyanine-green videoangiogram to assess collateral circulation before arterial sacrifice for management of complex vascular and neoplastic lesions: technical note","volume":"79","author":"Kim","year":"2013"},{"key":"b11-0360007","series-title":"Neurol India","first-page":"453","article-title":"Assessment of microscope-integrated indocyanine green angiography during intracranial aneurysm surgery: a retrospective study of 120 patients","volume":"57","author":"Li","year":"2009"},{"key":"b12-0360007","series-title":"Clin Neurol Neurosurg","first-page":"840","article-title":"Intraoperative indocyanine green angiography in intracranial aneurysm surgery: Microsurgical clipping and revascularization","volume":"111","author":"Ma","year":"2009"},{"key":"b13-0360007","series-title":"J Neurosurg","first-page":"526","article-title":"Intraoperative digital subtraction angiography and the surgical treatment of intracranial aneurysms and vascular malformations","volume":"73","author":"Martin","year":"1990"},{"key":"b14-0360007","series-title":"J Korean Neurosurg Soc","first-page":"349","article-title":"Value of indocyanine green videoangiography in deciding the completeness of cerebrovascular surgery","volume":"53","author":"Moon","year":"2013"},{"key":"b15-0360007","series-title":"World Neurosurg","first-page":"477.e7","article-title":"Intraoperative Matas test using microscope-integrated intraoperative indocyanine green videoangiography with temporary unilateral occlusion of the A1 segment of the anterior cerebral artery","volume":"76","author":"Murai","year":"2011"},{"key":"b16-0360007","series-title":"J Clin Neurosci","first-page":"1097","article-title":"Intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery","volume":"18","author":"Oda","year":"2011"},{"key":"b17-0360007","series-title":"Clin Neurol Neurosurg","first-page":"870","article-title":"How reliable and accurate is indocyanine green video angiography in the evaluation of aneurysm obliteration?","volume":"115","author":"\u00d6zgiray","year":"2013"},{"key":"b18-0360007","series-title":"Neurosurgery","first-page":"132","article-title":"Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow","volume":"52","author":"Raabe","year":"2003"},{"key":"b19-0360007","series-title":"Zentralbl Neurochir","first-page":"1","article-title":"Technique and image quality of intraoperative indocyanine green angiography during aneurysm surgery using surgical microscope integrated near-infrared video technology","volume":"66","author":"Raabe","year":"2005"},{"key":"b20-0360007","series-title":"J Neurosurg","first-page":"982","article-title":"Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"103","author":"Raabe","year":"2005"},{"key":"b21-0360007","series-title":"Acta Neurochir (Wien)","first-page":"1153","article-title":"Aneurysmal remnants after microsurgical clipping: classification and results from a prospective angiographic study (in a consecutive series of 305 operated intracranial aneurysms)","volume":"140","author":"Sindou","year":"1998"},{"key":"b22-0360007","series-title":"Neurosurg Rev","first-page":"209","article-title":"Evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery","volume":"34","author":"Wang","year":"2010"},{"key":"b23-0360007","series-title":"J Neurosurg","first-page":"420","article-title":"Comparing indocyanine green videoangiography to the gold standard of intraoperative digital subtraction angiography used in aneurysm surgery. Clinical article","volume":"118","author":"Washington","year":"2013"},{"key":"b24-0360007","series-title":"Neurosurgery","first-page":"970","article-title":"Intraoperative assessment of aneurysm clip placement by intravenous fluorescein angiography","volume":"35","author":"Wrobel","year":"1994"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/2\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/2\/article-pE7.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/36\/2\/article-pE7.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T08:40:15Z","timestamp":1777711215000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/36\/2\/article-pE7.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,2]]},"references-count":48,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.3171\/2013.11.focus13475","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,2]]}}}