Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery

Background Microscope-integrated near-infrared indocyanine green video angiography （ICG-VA） has been used in neurosurgery for a decade. This study aimed to assess the value of intraoperative indocyanine green （ICG） video angiography with Flow 800 software in cerebrovascular surgery and to discover its hemodynamic features and changes of cerebrovascular diseases during surgery. Methods A total of 87 patients who received ICG-VA during various surgical procedures were enrolled in this study. Among them, 45 cases were cerebral aneurysms, 25 were cerebral arteriovenous malformations （AVMs）, and 17 were moyamoya disease （MMD）. A surgical microscope integrating an infrared fluorescence module was used to confirm the residual aneurysms and blocking of perforating arteries in aneurysms. Feeder arteries, draining veins, and normal cortical vessels were identified by the time delay color mode of Flow 800 software. Hemodynamic parameters were recorded. All data were analyzed by SPSS version 18.0 （SPSS Inc., USA）. T-test was used to analyze the hemodynamic features of AVMs and MMDs, the influence on peripheral cortex after resection in AVMs, and superficial temporal artery to middle cerebral artery （STA-MCA） bypass in MMDs. Results The visual delay map obtained by Flow 800 software had more advantages than the traditional playback mode in identifying the feeder arteries, draining veins, and their relations to normal cortex vessels. The maximum fluorescence intensity （MFI） and the slope of ICG fluorescence curve of feeder arteries and draining veins were higher than normal peripheral vessels （MFI： 584.24±85.86 vs. 382.94_±91.50, slope： 144.95±38.08 vs. 69.20±13.08, P 〈0.05）. The arteriovenous transit time in AVM was significantly shorter than in normal cortical vessels （（0.60±0.27） vs. （2.08±1.42） seconds, P 〈0.05）. After resection of AVM, the slope of artery in the cortex increased, which reflected the increased cerebral flow. In patients with MMD, after STA-MCA bypass, cortex perfusion of corresponding branches region increased and local cycle time became shorter. Conclusion Intraoperative ICG video angiography combined with hemodynamic parameter analysis obtained by Flow 800 software appears to be useful for intraoperative monitoring of regional cerebral blood flow in cerebrovascular disease.