Use of a Yasargil Mirror as an Adjunct to Indocyanine Green Angiography to Evaluate the Patency of Elusive Posterior Communicating Arteries During Aneurysm Clipping: Case Report

BACKGROUND AND IMPORTANCE: Indocyanine green angiography (ICGA) has become a useful intraoperative tool during aneurysm surgery to determine parent, branching, and perforator vessel patency. Although extremely useful, ICGA is limited to the evaluation of vessels that are in direct view in the surgical field. CLINICAL PRESENTATION: We present 2 cases of patients who underwent a craniotomy for clipping of unruptured posterior communicating artery aneurysms. A Yasargil movable mirror was used as an adjuvant to ICGA to visualize the ventromedial posterior communicating vessels after clip placement to determine vessel patency. CONCLUSION: Although ICGA can be very useful during aneurysm surgery, it is limited to vessels directly visualized in the surgical field. A Yasargil movable mirror can be used during ICGA to visualize elusive vessels, in these cases on the ventromedial surface of the internal carotid artery.