The Application of FLOW 800 ICG Videoangiography Color Maps for Neurovascular Surgery and Intraoperative Decision Making.

BACKGROUND: Indocyanine green (ICG) videoangiography can assess cerebral blood flow, but results are primarily qualitative. FLOW 800 software measures fluorescence dynamics and creates a semiquantitative color delay map for assessment of relative sequence of blood flow within the vasculature.

METHODS: We retrospectively reviewed 23 consecutive patients for whom FLOW 800 ICG videoangiography was used. They harbored aneurysms, arteriovenous malformations (AVMs), dural arteriovenous fistula (dAVF), or hemangioblastoma. Patients' characteristics, FLOW 800 data, and clinical findings were recorded. Color map data were readily available intraoperatively and guided surgery.

RESULTS: The cohort included 10 patients with AVMs, 11 with aneurysms, 1 with dAVF, and 1 with hemangioblastoma. Approximately two thirds of patients underwent intraoperative angiography. FLOW 800 data provided semiquantitative data regarding localization, flow status in major feeding arteries, and dominance of the arterialized draining veins for AVMs, more than data from ICG videoangiography alone. For complex aneurysms, color maps confirmed relative adequate flow in parent and branching vessels. For the foramen magnum dAVF, the location of the dominant transdural connection was appreciated only via flow analysis. Flow analysis created the blood flow map of a large complex solid brainstem hemangioblastoma and guided devascularization. All FLOW 800 findings agreed with intraoperative and postoperative angiography.

CONCLUSIONS: ICG videoangiography with FLOW 800 analysis can provide semiquantitative and relative flow magnitude data that are efficient and noninvasive. This process helps identify early arterialized veins and their flow status during AVM and dAVF surgery and can confirm adequate relative flow within branching vessels during aneurysm surgery when clip-induced stenosis is suspected.