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Background <p>Surgical clipping of cerebral aneurysms aims to achieve complete aneurysm occlusion while preserving the patency of parent, branching, and perforating vessels. Inadvertent vascular compromise due to improper clip placement may result in ischemic complications and adverse neurological outcomes. Intraoperative indocyanine green video angiography (ICG-VA) has emerged as a practical and cost-effective tool for real-time assessment of vascular integrity and adequacy of clip placement. This prospective observational study aimed to evaluate the utility of intraoperative indocyanine green video angiography in detecting residual aneurysms and compromised vessels, and to analyze factors influencing postoperative outcomes.</p> Results <p>A total of 99 patients with cerebral aneurysms who underwent microsurgical clipping with intraoperative indocyanine green video angiography were prospectively analyzed. The mean age was 54.24 years, with a slight female predominance. The anterior communicating artery was the most common aneurysm location (49.49%). Intraoperative clip repositioning was required in 5.05% of cases based on indocyanine green video angiography findings. Residual aneurysms were detected in 3.03% of patients, and inadvertent vessel compromise occurred in 2.02%. Favorable neurological outcomes were observed in 68.69% of patients, while 26.26% recovered with minor deficits. Mortality was recorded in 5.05% of cases. Statistical analysis demonstrated a significant association between preoperative Glasgow Coma Scale scores and clinical outcomes (<i>p</i> = 0.003). Postoperative infarction was strongly correlated with unfavorable outcomes (<i>p</i> &lt; 0.001).</p> Conclusions <p>Intraoperative indocyanine green video angiography is a reliable, rapid, and cost-effective imaging modality that facilitates real-time assessment of aneurysm occlusion and vascular patency during microsurgical clipping. Its use was associated with timely clip adjustments and facilitated intraoperative decision-making and surgical precision. Although indocyanine green video angiography enhances intraoperative decision-making, its complementary use with other imaging modalities such as digital subtraction angiography may further optimize surgical safety, particularly in complex aneurysm cases.</p>

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Utility of intraoperative video-indocyanine green angiography in cerebral aneurysm clipping: a prospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月16日

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  • Vemula Venkata Ramesh Chandra,
  • Sree Datta Pradeep Kundum,
  • Venkatesh Vinod Kharalkar,
  • Praveen Yangannagari,
  • Bodapati Chandra Mowliswara Prasad,
  • Prithvi Kanduri

摘要

Background

Surgical clipping of cerebral aneurysms aims to achieve complete aneurysm occlusion while preserving the patency of parent, branching, and perforating vessels. Inadvertent vascular compromise due to improper clip placement may result in ischemic complications and adverse neurological outcomes. Intraoperative indocyanine green video angiography (ICG-VA) has emerged as a practical and cost-effective tool for real-time assessment of vascular integrity and adequacy of clip placement. This prospective observational study aimed to evaluate the utility of intraoperative indocyanine green video angiography in detecting residual aneurysms and compromised vessels, and to analyze factors influencing postoperative outcomes.

Results

A total of 99 patients with cerebral aneurysms who underwent microsurgical clipping with intraoperative indocyanine green video angiography were prospectively analyzed. The mean age was 54.24 years, with a slight female predominance. The anterior communicating artery was the most common aneurysm location (49.49%). Intraoperative clip repositioning was required in 5.05% of cases based on indocyanine green video angiography findings. Residual aneurysms were detected in 3.03% of patients, and inadvertent vessel compromise occurred in 2.02%. Favorable neurological outcomes were observed in 68.69% of patients, while 26.26% recovered with minor deficits. Mortality was recorded in 5.05% of cases. Statistical analysis demonstrated a significant association between preoperative Glasgow Coma Scale scores and clinical outcomes (p = 0.003). Postoperative infarction was strongly correlated with unfavorable outcomes (p < 0.001).

Conclusions

Intraoperative indocyanine green video angiography is a reliable, rapid, and cost-effective imaging modality that facilitates real-time assessment of aneurysm occlusion and vascular patency during microsurgical clipping. Its use was associated with timely clip adjustments and facilitated intraoperative decision-making and surgical precision. Although indocyanine green video angiography enhances intraoperative decision-making, its complementary use with other imaging modalities such as digital subtraction angiography may further optimize surgical safety, particularly in complex aneurysm cases.