Intraoperative infrared angiography in the spectral clipping of cerebral  aneurysms

L. Kravets *., A. Nikolaev **

*Federal State Institution “The Research Institute of Traumatology and Orthopedics of Nizhny Novgorod” of Public Ministry of Health of the Russian Federation. Nizhny Novgorod, Verhne-Volzhskaya naberezhnaya, 18/1, e-mail: Lkravetz@yandex.ru.

** Municipal Healthcare Institution "City Hospital No. 13", Nizhny Novgorod,

Patriots Street, 51.

Monitoring of adequacy of aneurysm clipping is an important stage of the operation. The optimal device for this case is cerebral angiography, which allows to control vascular permeability after clipping and to correct possible lapses of the operation. The aim of this study was the testing of method of intraoperative angiography (IOA) using an operating microscope with an integrated infrared module that allows to visualize the vasculature of the brain in the operation area.

Materials and methods. With the use of an IOA nine patients (5 women and 4 men) aged from 37 to 61 years were operated. In particular, 3 patients had aneurysms of the anterior communicating artery (ACoA), 3 patients had middle cerebral artery (MCA), 1 patient had a giant distal anterior cerebral artery (ACA) aneurysm, 1 patient had a large aneurysm of the supraclinoid segment of the internal carotid artery (ICA), 1 patient had a large aneurysm of the ophthalmic segment of the ICA. At a certain stage of the operation a reagent was intravenously injected, and after a short time the vessels in the area of operations started to "shine". Angiographic situation remained a few minutes, during this time it was possible to shift the clips if necessary.

Results and discussion. In clipping aneurysms ACoA, IOA allowed to dispel doubts about the patency of distal branches of ACA. With exclusion of multichamber aneurysms of MCA with wide neck and a lack of direct visualization of the place of origin of secondary trunks, IOA visualized their entrances and controlled complete clipping of the aneurysmal neck. The greatest value of this technique in aneurysms was understood in the cases with a rare localization. In the case of a giant aneurysm of ACA of which closed the neck with its volume IOA allowed to reveal the front - polar branch and avoid it getting into the aneurysm clips, as well as to recognize a paradoxical retrograde " supply " of the aneurysm from the pericallosal artery, which was transversed. In the case of a large aneurysm with a wide-necked ophthalmic segment of the ICA, IOA controlled maintaining of patency of the main carrying trunk of the ICA, and full clipping of the aneurysmal neck. A similar situation was with a large aneurysm of the ICA, when there was no certainty that the clips has fully pinched its neck. The large-scale implementation of IOA in practice will significantly improve the results of "open" surgery of cerebral aneurysms.