Our final speaker is Dr. Javier Fandino, who will compare three-dimensional cerebral angiography versus ICG for intracranial aneurysm surgery. Thank you. Thank you very much. I'm going to present a very simple and quick study on behalf of my group in Aaron, Switzerland. The introduction of ICG and 3D DSA improved the quality of visualization of aneurysm surgery and identification of permanent aneurysms. So actually, the study was designed to compare both techniques, ICG versus 3D DSA during aneurysm surgery. We included 140 cases. Variables analyzed included patient demographics, aneurysm-specific characteristic, ICG, and 3D DSA findings, and the need of introvertive clip readjustment. And we defined the discordance rate of the two modalities as a false negative finding that necessitates clip repositioning after performing 3D DSA. And these are the results. After visual inspection and Doppler sonography, we could identify 7% of aneurysm that where a reposition of the clip was needed. After ICG, there were 13 cases, 11% again. And after performing 3D intraoperative DSA, 6%. So the overall intraoperative reposition rate was in this series after performing these techniques, 24%. And very shortly, I'd like to just mention that these were normal, easy cases. Most of them were aneurysms under 7-millimeter size and located at the A-cone. And these are the seven cases of these years where a change of strategy was needed, most of them on the one clip repositioning. And one case had a wrapping of a remnant and another, an additional clip. So I want to show you a couple of cases. This first one is a 61-year-old patient with anoraptor 7-millimeter bilobular A-cone aneurysm. And in the 3D DSA before surgery, we could also demonstrate a wide neck of the aneurysm, very complex to clip. The aneurysm was clipped, and according to the findings interop with sonography and visualization, there was a satisfactory result. Also in the ICG. So the aneurysm was, according to this technique, occluded. Also in the interop 2D DSA, we were happy with this finding, but in the interop 3D DSA with open skull, we could identify a small remnant of the aneurysm which was occluded with an additional clip. Another case also where we could see a small remnant of the aneurysm, we decided interop to a wrapping, even if the finding in the 2D DSA were totally okay for us. In another case, for example, an aneurysm remnant treated by clip reposition, an aneurysm remnant which was not actually really seen in the 2D DSA, was shown in the 3D and we could optimize the occlusion. And here another case where a parent vessel was occluded, the clip was also repositioned. So in the literature, there are very few reports on comparison between these two techniques. Most of them were done using portable DSA and not 2D or 3D DSAs in the setting of the hybrid OR. And for example, in experienced hands like in Barrow, for example, we could also see that the necessity of adjustment of the clip ranged between 9 and 11%. So the conclusion of this short report is that it seems, even if ICG demonstrated high accuracy compared to 3D DSA, it seems to us that DSA and 3D DSA might be or can be confirmed as a gold standard. And improved imaging quality, including the interop 3D DSA, supports its routine use in aneurysm surgery, obviating the need probably for a postoperative DSA. Thank you very much.

three-dimensional cerebral angiography

indocyanine green

intracranial aneurysm surgery

clip readjustment

gold standard