Endoscopic Indocyanine Green Angiography for Endonasal Aneurysm Clipping
Eric Wang, Ezequiel Goldschmidt, Paul Gardner, Carl Snyderman, Salomon Cohen-Cohen, Bradley Gross, Pradeep Setty
Introduction: Indocyanine green angiography (ICG-A) is used routinely during microsurgical aneurysm clipping. The endoscopic endonasal (EE) approach for aneurysm clipping has been described as a viable option for rare, select cases. No reports currently exist on EEA and ICG near-infrared endoscopic angiography during aneurysm clipping.
Objective: The objective of this study is to describe the application and technique of these operations.
Methods: We present two patients with intracranial aneurysms arising from the proximal anterior inferior cerebellar artery (AICA)and from bilateral supraclinoid segments of the internal carotid arteries (ICAs) (bilateral aneurysms) which were successfully clipped through an EE approach with the use of intraoperative ICG-A.
Results: A 52-year-old asymptomatic female with a family history of ruptured intracranial aneurysms and incidental bilateral ICA aneurysms found on MRI screening underwent an EE transsellar bilateral transcavernous and transplanum approach to clip both aneurysms with the use of intraoperative ICG-A. Complete occlusion of the aneurysms and patency of the adjacent vasculature was achieved and confirmed with ICG. A 54-year-old female who suffered an acute, severe headache and presented to the emergency department secondary to a dissecting pseudoaneurysm of the right proximal anterior inferior cerebellar artery (AICA) underwent an EE transclival approach to clip the pseudoaneurysm with the use of intraoperative ICG-A. Patency of the adjacent vasculature and obliteration of the pseudoaneurysm was confirmed with ICG and intraoperative angiography.
Conclusions: The EE approach can be a safe and effective way to clip rare, well-selected aneurysms when done by experience skull base teams. The use of ICG may help improve surgical outcomes.