Multimodal microsurgical video-assisted occlusion of aneurysms of the anterior brain circulation: i mportance of the application of indocyanine green contrast and QEVO inspection - preliminary results.

Introduction: Indocyanine green (ICG) video angiography (VA) has been widely used in various medical indications, including neurosurgery. The technique enables real -time assessment of vascular structures during surgery. ICG VA is particularly useful in neurosurgery due to its ability to provide high-quality imaging of vascular structures. The aim of the study was to evaluate the practicality, feasibility, and importance of combining ICG VA with endoscopic inspection tool (QEVO) in improving the outcomes of aneurysm clipping surgery. Materials and methods: the study population comprised individuals admitted to the Clinic of Neurosurgery of the Clinical Center University of Sarajevo (CCUS), who underwent microsurgical clipping of the aneurysm. All patients included in the study were surgically treated with the occlusion of brain aneurysm. After the aneurysm was occluded with the clip video-assisted angiography using ICG contrast and endoscopically-assisted inspection of the occluded aneurysm and surrounding blood vessels, QEVO was used for the best clip positioning. Results: this preliminary study included a total of seven patients who fulfilled the inclusion criteria; five of them (71%) were female. After clipping of the anurysm control microscopic inspection revealed that in five patients (71%) the clip was well placed without the anurysm remains while the remains were detected in two patients. ICG video angiography showed that microscopic remains of the aneurysm were detected in one patient, with no angiographic signs of the aneurysm remains. In one patient where the microscopic clip appeared to be well placed, after ICG video angiography, the remains of the aneurysm were detected and the perforator arteries were occluded. Conclusion: the study aimed to evaluate the practicality, feasibility, and importance of combining ICG VA and QEVO in improving the outcomes of aneurysm clipping surgery. The results suggest that this combination can improve visualization of arteries and enhance the outcomes of aneurysm clipping surgery. The study highlights the importance of using both ICG VA and endoscope during microsurgical clipping of aneurysms to achieve better outcomes. [ABSTRACT FROM AUTHOR]