Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Efficacy of intraoperative neuromonitoring (IONM) and intraoperative indocyanine green videoangiography (ICG-VA) during unruptured anterior choroidal artery aneurysm clipping surgery

  • Chanbo Eun (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Seung Joo Lee (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung Cheol Park (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jae Sung Ahn (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Byung Duk Kwun (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Wonhyoung Park (Department of Neurosurgery, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2022.10.11
  • Accepted : 2023.01.05
  • Published : 2023.06.30
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Abstract

Objective: The aim of this study was to investigate the efficacy of intraoperative indocyanine green videoangiography (ICG-VA) and intraoperative neuromonitoring (IONM) to prevent postoperative ischemic complications during microsurgical clipping of unruptured anterior choroidal artery (AChA) aneurysms. Methods: We retrospectively reviewed the clinical and radiological records of all patients who had undergone microsurgical clipping for unruptured AChA aneurysms at our institution between April 2001 and December 2019. We compared the postoperative complication rate of the group for which intraoperative ICG-VA and IONM were utilized (group B; n=324) with that of the group for which intraoperative ICG-VA and IONM were not utilized (group A; n=72). Results: There were no statistically significant differences in demographic data between the two groups. Statistically significant differences were observed in the rate of overall complications (p=0.014) and postoperative ischemic complications related to AChA territory (p=0.039). All the cases (n=4) in group B who had postoperative infarctions related to AChA territory showed false-negative results of intraoperative ICG-VA and IONM. Conclusions: Preserving the patency of the AChA is essential to minimize postoperative complications. Intraoperative monitoring tools including ICG-VA and IONM can greatly contribute to lowering complication rates. However, their pitfalls and false-negative results should always be considered.

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References

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