吲哚菁绿术中血管造影在颅内动脉瘤的应用

吲哚菁绿血管造影是一种较新的评价脑血管内血流的术中监测手段,这一技术与手术显微镜整合后,可以提供术中动脉瘤、载瘤动脉以及周围相关动脉的实时血流信息,图像质量清晰,解析度高,可以有效地监测动脉瘤夹闭后是否残留、载瘤动脉是否狭窄及吻合血管、穿通血管是否通畅,对指导手术操作、提高手术质量和改善患者预后有着重要意义。同术中DSA、微血管多普勒超声及电生理检测等传统监测相比吲哚菁绿术中血管造影具有费用低廉,操作简便,耗时短,精确度高等明显优势,因此有可能在将来成为动脉瘤手术中的常规检查。     

吲哚菁绿荧光血管造影在颅内动脉瘤术中的应用(附56例分析)

目的探讨术中吲哚菁绿(Indocyanine green,ICG)荧光血管造影在开颅手术治疗颅内动脉瘤中的作用。方法回顾性分析开颅手术治疗56例颅内动脉瘤的经验。术中共行ICG荧光血管造影145次。结果3例手术得益于ICG荧光血管造影,经及时调整动脉瘤夹的位置或切断动脉瘤顶部的细小供血血管后,获得理想疗效。术中1例病人出现ICG过敏。术后复查3D-CTA或DSA检查51例,显示2例存在与血流不相关的载瘤动脉轻度狭窄,余49例结果与术中ICG荧光血管造影结果一致。结论ICG荧光血管造影简便易行,具有理想的空间和时间分辨率,可以帮助提高颅内动脉瘤手术质量,有可能成为颅内动脉瘤手术中的重要检查手段。     

吲哚菁绿血管造影在动脉瘤术中对穿通支血管保护的应用

目的 探讨吲哚菁绿血管造影在颅内动脉瘤手术中对穿通支血管的保护作用.方法 回顾性总结26例颅内动脉瘤术中暴露动脉瘤及夹闭动脉瘤后进行吲哚菁绿血管造影,观察动脉瘤、载瘤动脉及周围穿通支血管在夹闭前后的分布及显影情况,据此调整动脉瘤夹及评价手术满意与否.结果 术中共进行吲哚菁绿血管造影48次,3例各造影3次,夹闭后造影发现有穿通支被阻断,术中及时变换动脉瘤夹位置.术后全部复查头颅CT,没有出现穿通支血管损伤导致的缺血性脑梗死或功能障碍.结论 对穿通支血管的走行、分布、供应范围的深入理解及术中有效保护的同时,辅以吲哚菁绿血管造影,能够直观、即时、快速的判断穿通支血管是否通畅,有效保护穿通支血管,提高手术质量,改善患者预后.     

吲哚菁绿荧光强度分析在颅内动脉瘤术中的应用

目的 探讨吲哚菁绿血管造影及荧光强度分析在颅内动脉瘤夹闭术中的作用.方法回顾性分析吲哚菁绿血管造影及荧光强度分析在47例颅内动脉瘤患者夹闭术中的作用.术中行吲哚菁绿荧光血管造影,观察动脉瘤、载瘤动脉及分支血管的血流情况,并通过荧光强度分析软件进行分析.结果47例中有4例通过吲哚菁绿血管造影检测到动脉瘤夹闭不全,术中荧光强度分析为3例动脉瘤的夹闭提供了重要信息.结论 吲哚菁绿血管造影能在术中对术野血流情况进行实时的分析,而通过荧光强度分析可进一步提高吲哚菁绿血管造影对血流分析的准确性.     

吲哚菁绿造影在巨大动脉瘤手术中的应用

目的 探讨吲哚菁绿造影(ICGA)在颅内巨大动脉瘤(GIA)手术中的作用.方法 首都医科大学附属北京天坛医院神经外科自2007年3月至2009年10月行瘤体夹闭和(或)切除术治疗GIA患者57例(61个动脉瘤),术中瘤体夹闭前、后分别进行ICGA并做比较,术后行DSA或CTA检查观察有无瘤体残留,载瘤动脉是否畅通,并与术中瘤体夹闭后ICGA结果对比分析.结果 57例患者共行ICGA 128次,夹闭切除动脉瘤61个,ICGA可实时显示术野内血流循环,清晰显示动脉瘤、载瘤动脉和穿支血管.通过对比夹闭前、后的ICGA影像,4例患者追加或调整瘤夹后,ICGA显示无瘤体残留,无载瘤动脉和穿支血管闭塞,术后DSA与夹闭后ICGA显示一致.结论 ICGA做为术中血管成像技术的一种,对术中确认GIA与周围血管的关系、监测瘤颈是否残留和载瘤动脉及穿支动脉是否畅通具有重要意义.     

吲哚菁绿荧光血管造影在脑肿瘤手术中的应用

目的 探讨吲哚菁绿荧光血管造影在脑肿瘤手术中的作用.方法 回顾性分析102例脑肿瘤病人的临床资料,其中低级别胶质瘤14例,高级别胶质瘤56例,脑膜瘤18例,转移瘤12例,血管网状细胞瘤2例.所有病人均行吲哚菁绿荧光血管造影,并在整合荧光造影的手术显微镜下切除肿瘤.结果 本组共实施吲哚菁绿荧光血管造影205次,均成功完成;单次造影所需时间约4 min,术中可实时辨认造影血管的动脉期、毛细血管期和静脉期.术后出现一过性皮疹1例,所有病人均未出现严重过敏现象.结论 在肿瘤切除前,吲哚菁绿荧光血管造影可实时动态观察瘤内和瘤周血管的血流情况;肿瘤切除后,可观察保留血管的情况.吲哚菁绿荧光血管造影是一种快速、简便和安全的造影方法.     

吲哚菁绿荧光血管造影在前循环动脉瘤手术中的应用

目的探讨吲哚菁绿（ICG）脑血管造影在颅内前循环动脉瘤手术中的作用。方法回顾性研究2007年1月至2008年4月开颅手术治疗的前循环动脉瘤患者42例,荧光显微镜下观察术野中血管,指导手术操作。术后行3DCTA或DSA检查,评估术中ICG荧光造影对开颅手术治疗颅内动脉瘤的作用。结果术中确认动脉瘤颈残留2例,载瘤动脉分支血管闭塞1例,穿通血管误夹2例,重新调整动脉瘤夹位置后,再次荧光血管造影,证实动脉瘤颈夹闭满意,术后DSA（或MRA、CTA）均证实术中ICG造影结果。结论ICG血管造影是一种术中监测颅内动脉瘤颈是否残留、载瘤动脉是否狭窄及穿通支血管是否闭塞的重要检查手段。     

吲哚菁绿血管造影在脑血管病手术中的应用

吲哚菁绿血管造影近年来被术者成功用于脑血管病手术中病灶结构的显示,尤其在复杂脑血管病(如复杂动脉瘤、动静脉畸形等)手术中作用较大。该技术能在术中实时提供术野表浅部位的脑血管血流信息,且操作简单、影像清晰,具有理想的时间和空间分辨率,可部分取代术中DSA。本文阐述了ICG血管造影在颅内动脉瘤、脑血管畸形、颅内外血管搭桥手术中的具体应用情况。     

吲哚菁绿荧光造影在颅内动脉瘤夹闭术中的应用体会

目的 总结颅内动脉瘤夹闭术中吲哚菁绿荧光造影（ICGA）的优点及不足。方法 回顾分析2016年1月至2019年1月夹闭术治疗的291例（共334个动脉瘤）的临床资料，术中根据ICGA结果及时调整动脉瘤夹闭的方法，术后结合DSA或CTA证实夹闭效果。结果 术中ICGA结果显示所有动脉瘤均不显影。剪开或穿刺的复杂动脉瘤97例，其中11例（11.3%）仍有再出血，经调整动脉瘤夹后出血停止。术后CTA或DSA检查无动脉瘤显影。结论 ICGA阴性不能作为动脉瘤夹闭完全的评判标准，夹闭后瘤顶的穿刺或切开后无出血方能确定动脉瘤夹闭完全。     

动脉瘤夹闭术中辅助应用吲哚菁绿荧光造影的临床研究

目的 探讨动脉瘤夹闭术中辅助应用吲哚菁绿荧光造影(ICG)对手术的影响.方法 回顾分析动脉瘤夹闭术中辅助应用吲哚菁绿荧光造影及无造影辅助的共40例脑动脉瘤病例,比较两组患者术后脑缺血的发生率、预后情况以及术中造影对手术策略的影响.结果 20例术中辅助应用吲哚菁绿荧光造影的患者术后GOS分级显著高于非造影组,术后脑缺血...     

颅内动脉瘤夹闭术中荧光造影"假阴性"原因探讨

目的 探讨吲哚菁绿荧光血管造影在颅内动脉瘤夹闭术中"假阴性"的原因及处理措施.方法 回顾分析2008年11月-2011年10月7例颅内动脉瘤夹闭术中吲哚菁绿荧光血管造影"阴性"患者手术治疗经过,分析术中吲哚菁绿荧光血管造影在显示动脉瘤夹闭完全性方面的局限性及应对原则.结果 7例患者均于术中吲哚菁绿荧光血管造影显示"阴性".但在剪开或刺破动脉瘤瘤体后出现少量渗血.经迅速清理瘤颈渗血并调整动脉瘤瘤夹位置,渗血消失.结论 吲哚菁绿荧光血管造影是术中监测动脉瘤是否夹闭完全的重要方法.但具有一定局限性,瘤颈较宽、瘤颈血栓形成或血管壁粥样硬化,以及蛛网膜分离不完全等情况均可能导致"假阴性"结果.因此,对于术中夹闭动脉瘤后吲哚菁绿荧光血管造影"阴性"的患者,仍需配合其他监测方法,进一步确认动脉瘤夹闭情况.     

Use of indocyanine green videoangiography during intracranial aneurysm surgery reduces the incidence of postoperative ischaemic complications

Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (p < 0.001). Our study supports the use of ICGVA in aneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.     

吲哚菁绿术中荧光造影在脊髓硬脊膜动静脉瘘手术中的应用

目的 探引哚菁绿术中荧光造影术在脊髓硬脊膜动静脉瘘手术中的作用.方法 9例脊髓硬脊膜动静咏瘘患者,均经脊髓DSA确诊,行后正中全椎板切开,术中吲哚菁绿荧光造影明确供血动脉、引流静脉及瘘口,夹闭瘘口并选择性切除静脉血管畸形.结果 畸形血管位于颈段1例、胸段4例、胸腰段2例、腰段1例、胸腰骶段1例;介入栓塞不充分后转手术1例,介入栓塞微导管难以到位转手术8例;术后MRI显示髓周异常迂曲畸形血管消失,脊髓缺血水肿好转.术后症状消失2例,改善6例,无变化1例.结论 吲哚菁绿术中荧光造影能够明确供血动脉、引流静脉及瘘口情况,有效地提高了脊髓硬脊膜动静脉瘘手术的疗效.

Abstract：

Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG)videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs).Method In this retrospective analysis we examined nine cases of dAVFs, diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach.An operating microscope - integrated light source containing infrared excitation light illuminated the operating field and was used to visualize an intravenous bolus of ICG.The locations of fistulae, feeding arteries and draininig veins were identified and compared before and after surgical obhteration by intraoperative ICG videoangiography.Results In the nine cases the dAVFs involved one cervical cord, four thoracic cord,two thoracic lumbar cord, one lumbar cord and one thoracic and lumbosacral cord.One of them used to take an unsuccessful endovascular embolization, while the rest of them were given the operation right after diagnosed by the spinal angiography.Microscope-based ICG videoangiography identified the fistulous point(s),feeding arteries and draining veins in all nine cases,as confirmed by postoperative MRI which showed complete obliteration of the dAVFs with improved spinal blood supply and reduced spinal cord edema.After the operation the clini cal symptoms were nearly disappered in two cases, improved in six cases, and present no obvious changes in one case.Conclusions Intraoerative ICG videoangiography provides real -time information about the precise location of spinal dAVFs,the feeding arteries and the draining veins, as well as additional feeding aiteries unrevealed by the preoperative spinal angiography and residue pathologic blood vessels during the operation, which efficiently improves the surgical outcomes and prognosis.     

吲哚菁绿血管造影在颅内外搭桥手术中的应用

目的探讨吲哚菁绿（ICG）血管造影在颅内外血管搭桥术中判定吻合口通畅性方面的作用。方法回顾性分析2009年12月至2012年12月57例患者的临床资料,共行颅内外搭桥手术61例次,共68处吻合口。吻合术后均行ICG血管造影,观察搭桥血管通畅情况,并与术后1周内的数字减影血管造影（DSA）或CT血管造影（CTA）检查结果比较。结果术中ICG血管造影有良好的时间和空间分辨率,发现4处吻合口闭塞,给予重新吻合。最终造影显示67处通畅,1处闭塞。术后DSA和CTA检查示66处吻合口通畅,2处闭塞。结论术中ICG血管造影可以判断颅内外搭桥吻合口的通畅性,是一种简便、迅速、准确的术中血管造影技术。     

Intraoperative indocyanine green angiography in intracranial aneurysm surgery: Microsurgical clipping and revascularization

Background

The goal of this report is to illustrate the use of intraoperative indocyanine green (ICG) angiography in the surgical management of intracranial aneurysms, including microsurgical clipping and revascularization.

Methods

This study included a series of 45 patients who were surgically treated between June 2007 and May 2008 for intracranial aneurysms. Fourty-three of the patients had anterior circulation aneurysms, and 2 had posterior circulation aneurysms. Forty-one patients were treated with microsurgical clipping. Four patients underwent revascularization combined with aneurysm dissection or trapping. Intraoperative ICG angiography was used to visualize the aneurysm clipping, patency of parent artery or graft. The ICG angiography technique is described, with particular reference to evaluation of the aneurysm clipping and revascularization.

Results

Eighty-nine ICG angiography procedures were performed in 45 patients with intracranial aneurysms. The aneurysms were completely obliterated for all patients, and the grafts were patented for all except 1 patient. Pre-clipping ICG angiography showed the relationship of aneurysm and its parent artery clearly. After aneurysms being clipped, intraoperative ICG angiography found remnant of aneurysms, stenosis or occlusion of parent arteries and grafts in 8 cases, which were revised in the same surgical procedure. The results of ICG angiography correlated well with postoperative DSA in 97% patients.

Conclusion

ICG angiography can provide real-time information and guide revision in the same surgical procedure for the management of intracranial aneurysms.     

前循环破裂动脉瘤急诊手术处理

目的 探讨前循环破裂动脉瘤急诊手术处理的注意事项.方法 对1996年6月至2011年10月期间无锡解放军一○一医院因前循环动脉瘤破裂而住院的508例急诊患者的临床资料进行回顾性分析.结果 508例患者均在蛛网膜下腔出血3d内手术,采用额颞入路或标准翼点入路503例,经前纵裂入路5例;508例中去骨瓣减压55例.手术动脉瘤瘤颈夹闭453例,夹闭加包裹32例,中动脉动脉瘤孤立加颞浅动脉和大脑中动脉搭桥手术5例,早年行单纯包裹18例.其中同侧多发性动脉瘤一次手术夹闭2个动脉瘤35例,双侧多发动脉瘤早年多夹闭处理出血的责任动脉瘤22例.术中吲哚菁绿(ICG)荧光血管造影89例,10例调整瘤夹位置瘤颈获得满意夹闭,术后常规行CTA检查.所有患者均经过0.5 -15年的随方,良好361例,中残59例,重残42例,植物生存14例,死亡和自动出院32例.结论 对于前循环破裂动脉瘤Hunt - Hess Ⅰ～Ⅲ级的患者急诊手术,Ⅳ～Ⅴ级伴血肿或急性脑积水和脑室积血的患者也应急诊手术同时行去骨瓣减压或脑室引流;急诊CTA可作为其首选常规筛查手段;术中ICG荧光造影可作为有效的辅助监测手段.     

吲哚菁绿术中荧光造影辅助下脊髓血管畸形的手术治疗

目的 总结吲哚菁绿术中荧光造影辅助下脊髓血管畸形的手术疗效.方法 自2009年8月至2011年5月,共收治脊髓血管畸形24例,在吲哚菁绿术中荧光造影辅助下行手术切除畸形血管团或夹闭畸形血管瘘口,对其疗效进行随访.结果 除1例外,术中荧光造影确认瘘口完全夹闭或髓内畸形血管团完全切除.脊髓正常血供和静脉回流得以满意保留.21例获得随访,术后3例失访.其中痊愈6例,改善10例,稳定2例,加重3例.结论 吲哚菁绿术中荧光造影可以有效地提高脊髓血管畸形的手术疗效.     

颅内动脉瘤显微手术治疗措施

目的探讨颅内动脉瘤显微手术治疗措施,以提高动脉瘤的手术疗效。方法回顾分析56例59个颅内动脉瘤显微手术治疗的时机、手术入路、术中和术后的处理。结果55例58个动脉瘤均获夹闭,1例行孤立术后死亡;随访6月至10年,55例均恢复日常工作生活。结论合理的手术措施对颅内动脉瘤包括多发性动脉瘤的治疗效果是至关重要的。