Abstract Background Intraoperative fluorescence-guided imaging has emerged as a valuable adjunct in vascular neurosurgery, providing real-time visualization of cerebrovascular architecture, blood flow dynamics, and vessel patency. Indocyanine green and fluorescein sodium are the most commonly used agents, aiding microsurgical procedures including aneurysm clipping, arteriovenous malformation resection, bypass surgeries, and cavernous malformation excision. Methods We conducted a retrospective analysis of 154 patients treated between January 2020 and December 2024 at the Instituto Nacional de Neurología y Neurocirugía “Manuel Velasco Suárez” in Mexico City. Patients underwent microsurgical intervention assisted by ICG or fluorescein sodium using KINEVO 900 or OPMI Pentero surgical microscope with FLOW 800 and YELLOW 560 filters. Functional outcomes were assessed using the modified Rankin Scale (mRS). Intraoperative identification of feeding arteries, draining veins, and vessel patency was documented, and postoperative imaging confirmed completeness of resection or bypass patency. Statistical analyses included Shapiro-Wilk, Student´s t-test, Wilcoxon signed-rank, and chi-square test as appropriate. Results Fluorescence-guided techniques were successfully applied in all cases without adverse events. In AVM and aneurysm surgery, both agents improved intraoperative visualization and assisted in confirming complete lesion removal or parent vessel preservation. Bypass procedures benefitted from immediate assessment of anastomotic patency, although one-third of patients developed postoperative stenosis or occlusion. Cavernous malformations demonstrated limited fluorescence uptake, highlighting the technique’s lesion-specific applicability. Functional outcomes (mRS) did not significantly improve across the cohort, reflecting the influence of baseline neurological status and lesion characteristics. Conclusion Intraoperative fluorescence imaging is a safe, efficient, and reproducible adjunct in cerebrovascular neurosurgery. While it does not replace conventional angiography, it enhances surgical confidence and intraoperative decision-making. Standardized protocols and long-term multicenter studies are warranted to further define its comparative advantages and impact on neurological outcomes.
Nathal et al. (Mon,) studied this question.