Intraoperative Dynamic Assessment of the Posterior Communicating Artery and Its Branches by Indocyanine Green Videoangiography

Background and Importance: True hemodynamic assessment of the posterior communicating artery (PComA) by preoperative angiography in terms of its perforators and configuration (adult versus fetal versus transitional) can be challenging in the surgical treatment of aneurysms involving the PComA, posterior cerebral artery and basilar artery. Indocyanine green videoangiography (ICG-VA) is a widely accepted new technique in the surgical treatment of intracranial aneurysms to assess the patency of the parent artery, branches and residual flow within the aneurysm after clipping.

Clinical Presentation: Here we report three cases in which ICG-VA was utilized to assess either the direction of flow in the PComA or preservation of the PComA perforators with temporary clip application before dividing the PComA.

Conclusion: Our experience is that ICG-VA can be used to assess the main trunk, perforating branches of the PComA and the flow direction, providing real-time, dynamic intraoperative information of the surgical field. Therefore we suggest that ICG-VA may increase the safety of surgical treatment of aneurysm involving PComA and this will be presented in surgical videos of three cases.