MCA Aneurysm: Intraoperative Fluorescence
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I would like to use this short video to describe the superiority of fluorescein fluorescence compared to ICG fluorescence for evaluation of small perforating vessels during aneurysm clip ligation. This is a 62-year-old female who presented with an incidental nine millimeter left sided MCA aneurysm. You can see the morphology of the aneurysm is pointing inferiorly and anteriorly. Left frontotemporal craniotomy was accomplished. Seven fissure was widely dissected. You can see the location of M1. One of M2 branches and its origin. Temporal branches being dissected. Temporary clip was placed and a definitive clip exclusion of aneurism at its neck was performed. You can see the origin of the M2 trunk, just at the tip of the clip. Let's review the findings over ICG and fluorescence. You can see the small perforating vessels around the dome of aneurysm are more apparent. Why are the fluorescein angiogram rather than the ICG? You can see their location here, but similar findings were not available on ICG angiogram. Here's the final result. Thank you.
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