Failure of Intraoperative Indocyanine Green (ICG) Videoangiography to Detect a Clip Occlusion of an Aneurysm –  a Case Report

Authors: V. Přibáň 1;  I. Holečková 1;  J. Mraček 1;  V. Runt 1;  D. Štěpánek 1;  F. Šlauf 2
Authors‘ workplace: LF UK a FN Plzeň Neurochirurgické oddělení 1;  LF UK a FN Plzeň Klinika zobrazovacích metod 2
Published in: Cesk Slov Neurol N 2013; 76/109(6): 773-778
Category: Case Report


Intraoperative indocyanine green (ICG) videoangiography is now widely used in aneurysm surgery because of its reliability and safety. ICG videoangiography is able to evaluate patency of parent, branching and perforating arteries and documents clip occlusion of aneurysms. False interpretation of ICG videoangiography may occur when viewing aneurysms and arteries located deep in the visual field. The authors present a case of unruptured large left middle cerebral artery aneurysm in a 65-year-old woman in whom ICG videoangiography wrongly displayed clip occlusion of the aneurysm. ICG videoangiography confirmed blood flow in parent, branching and perforating arteries, the sac behind the clip did not fill with contrast. Fundus puncture caused bleeding and, consequently, contrast material occurred in the sac. We added more clips (totalling five) and we succeeded to stem the inflow of blood into the sac. The authors emphasize the need for opening the sac after clipping. Full reliance on ICG videoangiography could lead to erroneous aneurysm treatment with an uncertain long‑term result.

Key words:
intracranial aneurysms – clipping – indocyanine green – videoangiography

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


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Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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2013 Issue 6

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