Sodium fluorescein video Angiography-Assisted clipping of intracranial Aneurysms: A systematic review and Meta-Analysis

Abstract

Objectives: Ensuring aneurysm exclusion while maintaining vessel patency is crucial during intracranial aneurysm clipping. Although digital subtraction angiography (DSA) is the gold standard for intraoperative vascular imaging, some centers have reported using fluorescein sodium video angiography (FNa-VA). However, a synthesis of these findings is still lacking. We aim to evaluate the safety and efficacy of FNa-VA in identifying aneurysm remnants and vessel stenosis post-clipping.

Methods: PubMed, Embase, Cochrane, and Web of Science databases were searched for studies reporting on FNa-VA for intraoperative aneurysm clipping assessment. We assessed the rate of mis-clippings identified by FNa-VA, false negatives, and procedure-related side effects. A diagnostic assessment analyzed FNa-VA's sensitivity, specificity, PPV, and NPV. Single proportion analysis with 95% confidence intervals under a random effects model was used, with heterogeneity examined via I2 and leave-one-out analysis.

Results: Eight studies involving 280 patients with 311 aneurysms were included. FNa-VA identified mis-clippings that eluded visual inspection in 11.94 % of cases (95 % CI: 5.83-18.05, I² = 59 %), with false negatives in 2.15 % (95 % CI: 0-5.13, I² = 44 %). It has demonstrated a sensitivity of 50 % and a specificity of 93 %, with PPV and NPV of 52 % and 93 %, respectively. Procedure-related side effects were yellow skin and green urine for 2-3 days following the procedure.

Conclusion: FNa-VA may reduce the risk of mis-clipping during aneurysm surgery, however, it is still prone to false negatives and should be considered a complementary tool rather than used alone. Additionally, it appears to have a safe profile with only mild and transitory side effects.

Keywords: Aneurysm; Angiography; Clipping; Sodium Fluorescein.