Microscopic
indocyanine green videoangiography (
mICG-VA) has gained wide acceptance during
intracranial aneurysm surgery by lowering rates of incomplete clipping and occlusion of surrounding vessels. However,
mICG-VA images are limited to the microscopic view and some deeper areas, including the
aneurysm sac/neck posterior side, cannot be efficiently assessed as they are hidden by the
aneurysm, clips, or surrounding structures. Contrarily,
endoscopes allow a wider area of visualization, but neurosurgical
endoscopes to date only provided visual data. We describe the first application of
endoscope ICG-integrated technology (eICG) applied in an initial case of
anterior communicating artery aneurysm clipping. This new technique provided also relevant information regarding
aneurysm occlusion and patency of parent and branching vessels and small perforating arteries. eICG-VA provided additional information compared to
mICG-VA by magnifying areas of interest and improving the ability to view less accessible regions, especially posterior to the
aneurysm clip. Obtaining eICG sequences required currently the microscope to be moved away from the operating field. eICG-VA was only recorded under infrared illumination which prevented tissue handling, but white-infrared light views could be interchanged instantaneously. Further development of angled
endoscopes integrating the ICG technology and dedicated filters blocking the microscopic light could improve visualization capacities even further. In conclusion, as a result of its ability to reveal structures around corners, the eICG-VA technology could be beneficial when used in combination with
mICG-VA to visualize and confirm vessel patency in areas that were previously hidden from the microscope.