Near-infrared indocyanine green video angiography in aneurysm surgery.

The most important goal of a vascular neurosurgeon during an intracranial aneurysm clipping is achieving complete exclusion of the aneurysm from the circulation with preservation of blood flow distal to the aneurysm. Occlusion of the parent vessel or distal branches due to improper clip application has been a significant factor in the poor outcome. Similarly, incomplete clipping of an aneurysm has been associated with aneurysmal growth and potential for future rupture. In the literature, partial aneurysm clipping with residual neck has been cited in 4-19% of cases while in an equally significant population (0.3-12%) inadvertent occlusion of the major vessels occurs. Though in the latter group, surgery has been often performed to reposition the clip, there has been questionable improvement in the overall outcome.