Usefulness of a New High-resolution Intraoperative Imaging System to Simultaneously Visualize Visible Light and Near-infrared Fluorescence for Indocyanine Green Angiography

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  • 可視光像と近赤外蛍光像をハイビジョンで同一画面にて観察可能な顕微鏡カメラシステムの有用性

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Objective: Indocyanine green videoangiography (ICG-VA) has been widely used in vascular surgery. While vessels are clearly visible as white regions on a black background, other structures cannot be observed. We developed a new system to simultaneously capture both, light and near-infrared (NIR) fluorescence images in ICG-VA (dual-image VA [DIVA]), allowing for observation of other cranial structures. We are attempting to make this technology commercially available.<br>Materials and Methods: We used our new technology with 10 different neurovascular cases. The operative field was illuminated via an operating microscope (OPMI PENTERO 900; Carl Zeiss Meditec, Jena, Germany). In the camera unit, visible light was filtered to 400-700 nm. NIR fluorescence emission light was filtered to 800-900 nm using a special sensor unit with an optical filter. Light and NIR fluorescence images were simultaneously visualized on a single monitor.<br>Results: All 10 cases showed a clearly visualized operative field including both fluorescence-enhanced blood vessels and other cranial structures. In aneurysm surgeries, we were able to confirm complete clipping and preserve blood flow in the parent and perforating arteries. In cases of arteriovenous malformation, feeding arteries, nearby passing arteries, and draining veins were all easily visualized and detected.<br>Conclusions: We developed a high-resolution intraoperative imaging system to enable real-time visualization of the color operative field along with ICG fluorescence-enhanced blood flow.

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