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The primary aim of this study is to assess the value of intraoperative near-infrared indocyanine green videoangiography (ICGA) during intracranial aneurysm surgery. Altogether, 129 patients harboring 152 intracranial aneurysms were recruited in this study between March 2007 and December 2008 and the clinical data were retrospectively analyzed. Intraoperative ICGA was performed to examine the completeness of the aneurysm clipping and the patency of the parent arteries in all cases. The intraoperative findings were compared with that of postoperative digital subtraction angiography (DSA). On all of the patients, 276 successful ICGA investigations were performed intraoperatively. The image quality and resolution were excellent, allowing real-time assessment of the cerebral circulation. Indocyanine green (ICG) angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with postoperative DSA. In all cases, the postoperative angiographic results corresponded to the intraoperative ICGA findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure. Intraoperative ICG videoangiography may be a useful tool in real-time evaluation of the aneurysm clipping. Its simplicity and easy reproducibility all suggest it to be carried out as a routine procedure during aneurysm surgery.

The objective of this study was to retrospectively investigate the surgical indications, operation methods, and postoperative results of patients with cavernous malformations (CMs) and the use of neuronavigation. Seventy patients with CMs were operated on in our hospital. The initial symptoms were hemorrhage in 31 cases, seizures in 29 cases, focal neurological deficit in 4 cases, and headache in 5 cases. Only one asymptomatic case was incidentally identified by radiological examination. The size of CMs ranged from 5 to 50 mm (mean: 21 mm). The CMs in 39 patients were located within the white matter of the hemispheres, 11 within the basal ganglia or thalamus, 5 within the cerebellum, and 6 in multiple locations. Prior to the operation, five fiducial markers were placed on the scalp and magnetic resonance imaging (MRI) was performed. Data were transferred to the neuronavigation workstation, a profile of tumors was drawn up, and a three-dimensional reconstruction was completed. The foci were separated and resected under a microscope through a sulci and fissures approach. All the lesions were resected totally. No residual foci were found by postoperative computed tomography (CT)/MRI examination, and there was no operative death. The disability rate was 8.6%; four patients had a new transitory neurological deficit within 1 month after the operation, and one patient with thalamic CMs developed facial paralysis. All patients, however, recovered in 6 months. Twenty-four patients with preoperative epilepsy were followed up for 6-24 months (mean: 19.4 months). After the operation, seizures disappeared in 19 patients and symptoms improved in 5. CMs can be determined in patients even if patients are asymptomatic. Surgical treatment should be considered if bleeding occurs. An operation with the guidance of neuronavigation is safe and can decrease the occurrence of disability following the procedure.

The utility of a neuronavigation system in the transsphenoidal surgery of pituitary macroadenoma was evaluated, and improvement of the surgical outcome is discussed. From 1997 to 2003, a total of 63 patients (male:female=41:22, mean age 58.3 years) with pituitary macroadenoma were treated surgically via transsphenoidal approach using a neuronavigation system in Beijing Tiantan Hospital. Image data for computed tomography or magnetic resonance were obtained and analyzed by the navigation system to make a three-dmensional reconstruction. During the operation, the tumor and its surrounding structures of the sellar region could be located accurately at any time. Among these cases, the tumors were removed totally in 26 cases (41.3%), subtotally in 36 cases (57.1%) and partially in one case (1.6%). Postoperative neurological complications occurred in 15 cases (23.8%). One patient died, the operative mortality was 1.6%. During the operation, the accuracy of the neuronavigation system was 2.3+/-1.1 mm. The neuronavigation system is quite helpful for transsphenoidal surgery of pituitary macroadenoma. Its accuracy of location is very useful and important in determining anatomical structure and protecting normal tissues and vessels. Moreover, fluoroscopy was not required during the surgery.