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Background
Videoangiography using indocyanine green (ICG) has been used in the ophthalmologic field for a long time. It was introduced to the neurosurgical field several years ago but has been limited to vascular surgeries. We applied ICG videoangiography to brain tumor surgery and evaluated the usefulness. 相似文献3.
Wang Shuo Liu Ling Zhao Yuanli Zhang Dong Yang Mingqi Zhao Jizong 《Neurosurgical review》2011,34(2):209-215
Neurosurgical Review - The primary aim of this study is to assess the value of intraoperative near-infrared indocyanine green videoangiography (ICGA) during intracranial aneurysm surgery.... 相似文献
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The primary aim of this study is to assess the value of intraoperative near-infrared indocyanine green videoangiography (ICGA)
during intracranial aneurysm surgery. Altogether, 129 patients harboring 152 intracranial aneurysms were recruited in this
study between March 2007 and December 2008 and the clinical data were retrospectively analyzed. Intraoperative ICGA was performed
to examine the completeness of the aneurysm clipping and the patency of the parent arteries in all cases. The intraoperative
findings were compared with that of postoperative digital subtraction angiography (DSA). On all of the patients, 276 successful
ICGA investigations were performed intraoperatively. The image quality and resolution were excellent, allowing real-time assessment
of the cerebral circulation. Indocyanine green (ICG) angiographic results could be divided into arterial, capillary, and venous
phases, comparable to those observed with postoperative DSA. In all cases, the postoperative angiographic results corresponded
to the intraoperative ICGA findings. In three cases, the information provided by intraoperative ICG angiography significantly
changed the surgical procedure. Intraoperative ICG videoangiography may be a useful tool in real-time evaluation of the aneurysm
clipping. Its simplicity and easy reproducibility all suggest it to be carried out as a routine procedure during aneurysm
surgery. 相似文献
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Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green videoangiography during aneurysm surgery 总被引:4,自引:0,他引:4
Raabe A Nakaji P Beck J Kim LJ Hsu FP Kamerman JD Seifert V Spetzler RF 《Journal of neurosurgery》2005,103(6):982-989
OBJECT: The authors prospectively compared a new technique of surgical microscope-based indocyanine green (ICG) videoangiography with intraoperative or postoperative digital subtraction (DS) angiography. METHOD: The technique was performed during 187 surgical procedures in which 124 aneurysms in 114 patients were clipped. Using a newly developed setup, the ICG technique has been integrated into an operating microscope (Carl Zeiss Co., Oberkochen, Germany). A microscope-integrated light source containing infrared excitation light illuminates the operating field. The dye is injected intravenously into the patient, and intravascular fluorescence from within the blood vessels is imaged using a video camera attached to the microscope. The patency of parent, branching, and perforating arteries and documentation of clip occlusion of the aneurysm as shown by ICG videoangiography were compared with intraoperative or postoperative findings on DS angiography. The results of ICG videoangiography corresponded with intra- or postoperative DS angiography in 90% of cases. The ICG technique missed mild but hemodynamically irrelevant stenosis that was evident on DS angiography in 7.3% of cases. The ICG technique missed angiographically relevant findings in three cases (one hemodynamically relevant stenosis and two residual aneurysm necks [2.7% of cases]). In two cases the missed findings were clinically and surgically inconsequential; in the third case, a 4-mm residual neck may require a second procedure. Indocyanine green videoangiography provided significant information for the surgeon in 9% of cases, most of which led to clip correction. CONCLUSIONS: Microscope-based ICG videoangiography is simple and provides real-time information about the patency of vessels of all sizes and about the aneurysm sac. This technique may be useful during routine aneurysm surgery as an independent form of angiography or as an adjunct to intra- or postoperative DS angiography. 相似文献
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Background
The authors assessed the usefulness of intraoperative near-infrared indocyanine green videoangiography (ICG-VA) in the microscopic resection of hemangioblastomas. 相似文献7.
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Background
Intraoperative fluorescence angiography with indocyanine green (ICG) as a tracer has recently been introduced as a novel technique for neurosurgery. We evaluated the feasibility and efficacy of near-infrared (NIR) indocyanine green (ICG) videoangiography for patients undergoing carotid endarterectomy (CEA). 相似文献11.
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Faber F Thon N Fesl G Rachinger W Guckler R Tonn JC Schichor C 《Acta neurochirurgica》2011,153(11):2181-2187
In cerebral arterioveneous malformations (AVMs) detailed intraoperative identification of feeding arteries, nidal vessels
and draining veins is crucial for surgery. Intraoperative imaging techniques like indocyanine green videoangiography (ICG-VAG)
provide information about vessel architecture and patency, but do not allow time-dependent analysis of intravascular blood
flow. Here we report on our first experiences with analytical indocyanine green videoangiography (aICG-VAG) using FLOW 800
software as a useful tool for assessing the time-dependent intraoperative blood flow during surgical removal of cerebral AVMs.
Microsope-integrated colour-encoded aICG-VAG was used for the surgical treatment of a 38-year-old woman diagnosed with an
incidental AVM, Spetzler Martin grade I, of the left frontal lobe and of a 26-year-old man suffering from seizures caused
by a symptomatic AVM, Spetzler Martin grade III, of the right temporal lobe. Analytical ICG-VAG visualization was intraoperatively
correlated with in situ micro-Doppler investigation, as well as preoperative and postoperative digital subtraction angiography
(DSA). Analytical ICG-VAG is fast, easy to handle and integrates intuitively into surgical procedures. It allows colour-encoded
visualization of blood flow distribution with high temporal and spatial resolution. Superficial major and minor feeding arteries
can be clearly separated from the nidus and draining veins. Effects of stepwise vessel obliteration on velocity and direction
of AVM blood flow can be objectified. High quality of visualization, however, is limited to the site of surgery. Colour-encoded
aICG-VAG with FLOW 800 enables intraoperative real-time analysis of arterial and venous vessel architecture and might, therefore,
increase efficacy and safety of neurovascular surgery in a selected subset of superficial AVMs. 相似文献
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正脊髓血管母细胞瘤是一种高度血管化的良性肿瘤,首选手术治疗,肿瘤全切者可达根治。但是手术中易出现难以控制的出血,造成视野不清,盲目地切瘤和止血容易造成脊髓严重损伤。神经外科医师一直致力于寻找最安全切除脊髓血管母细胞瘤手术的辅助工具,包括术前数字减影血管造影(digital subtraction angiography,DSA)、术前三维CT血管造影(three-dimensional computed tomography 相似文献
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Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography 总被引:4,自引:0,他引:4
OBJECT: Recently, intraoperative fluorescence angiography in which indocyanine green (ICG) is used as a tracer has been introduced as a novel technique to confirm successful aneurysm clipping. The aim of the present study was to assess whether ICG videoangiography is also suitable for intraoperative confirmation of extracranial-intracranial bypass patency. METHODS: Forty patients undergoing cerebral revascularization for hemodynamic cerebral ischemia (11 patients), moya-moya disease (18 patients), or complex intracranial aneurysms (11 patients) were included. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass surgery was performed 35 times in 30 patients (five patients with moyamoya underwent bilateral procedures), STA-posterior cerebral artery bypass surgery in two patients, and saphenous vein (SV) high-flow bypass surgery in eight patients. In each patient, following the completion of the anastomosis, ICG (0.3 mg/kg body weight) was given systemically via an intravenous bolus injection. A near-infrared light emitted by laser diodes was used to illuminate the operating field and the intravascular fluorescence was recorded using an optical filter-equipped video camera. The findings of ICG videoangiography were compared with those of postoperative digital subtraction (DS) or computerized tomography (CT) angiography. In all cases excellent visualization of cerebral arteries, the bypass graft, and brain perfusion was noted. Indocyanine green videoangiography was used to identify four nonfunctioning STA-MCA bypasses, which could be revised successfully in all cases. In two cases of SV high-flow bypasses, ICG videoangiography revealed stenosis at the proximal anastomotic site, which was also revised successfully. In all cases the final findings of ICG videoangiography could be positively validated during the postoperative course by performing DS or CT angiography. CONCLUSIONS: Indocyanine green videoangiography provides a reliable and rapid intraoperative assessment of bypass patency. Thus, ICG videoangiography may help reduce the incidence of early bypass graft failure. 相似文献
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Background
Cerebral cavernous malformations (CCMs) are known to be vascular anomalies with low perfusion because of being angiographically occult. We attempted direct visualization of blood flow within CCMs and orbital cavernous angiomas (CAs), and analyzed flow dynamics using indocyanine green videoangiography (ICG-VAG). 相似文献16.
Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow 总被引:25,自引:0,他引:25
OBJECTIVE: We report our initial clinical experience with a new method for intraoperative blood flow assessment. The purposes of the study were to assess the use of indocyanine green (ICG) video angiography in neurovascular cases, to assess the handling and image quality, to compare the findings with postoperative angiographic results, and to evaluate the clinical value of the method in a preliminary feasibility study. METHODS: Fourteen patients with aneurysms (n = 12) or spinal (n = 1) or intracranial (n = 1) dural fistulae were included. Before and/or after aneurysm or dural fistula occlusion, ICG (25 mg) was injected intravenously. A near-infrared laser excitation light source (lambda = 780 nm) illuminated the operating field. The intravascular fluorescence of ICG (maximal lambda = 835 nm) was recorded by a nonintensified video camera, with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence. RESULTS: A total of 21 investigations were performed for 14 patients. For the 17 successful ICG video angiographic investigations, image quality and resolution were excellent, allowing intraoperative real-time assessment of the cerebral circulation. ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with digital subtraction angiography. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure. CONCLUSION: ICG video angiography is simple and provides real-time information on the patency of arterial and venous vessels of all relevant diameters, including small and perforating arteries (<0.5 mm), and the visible aneurysm sac. It may be a useful adjunct to improve the quality of neurovascular procedures and to document the intraoperative vascular flow. 相似文献
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Alessandro Della Puppa Oriela Rustemi Giorgio Gioffrè Francesco Causin Renato Scienza 《Acta neurochirurgica》2014,156(9):1761-1767
Background
The role of indocyanine green video-angiography (ICG-VA) in the surgical resection of vascular malformations has been largely described; conversely, the utility of ICG-VA before dural opening (transdural ICG-VA) in this situation remains unclear. The aim of this study is to present the application of transdural ICG-VA in a consecutive series of patients in order to explore the potential provided by a transdural visualisation of vascular malformations.Method
We retrospectively analysed the application of intra-operative ICG-VA before dural opening in 15 consecutive patients who underwent surgical resection of vascular malformations. The cases included 12 cerebral arterio-venous malformations (AVMs), 2 cerebral dural arterio-venous fistulas (dAVFs) and 1 spinal arterio-venous fistula (AVF).Results
ICG-VA before dural opening allowed the visualisation of the site and extension of the malformation in 13 out of 15 cases, whilst arterial feeders and venous drainages were identified in 9 out of 15 cases. In two patients with dAVF, the point of fistula could be transdurally identified through ICG-VA. In 14% of cases, the size of bone flap designed on neuronavigation data was then modified according to transdural ICG-VA findings.Conclusions
Transdural ICG-VA proved an efficient tool that allows optimising the exposure of the malformation, performing a safe dural opening and identifying dural vascular connections of the lesion. 相似文献19.
Limitation of temporary vascular occlusion during aneurysm surgery Study by intraoperative monitoring of cortical blood flow 总被引:1,自引:0,他引:1
Akira Ogawa M.D. Hiroo Sato M.D. Yoshiharu Sakurai M.D. Takashi Yoshimoto M.D. 《Surgical neurology》1991,36(6):453-457
The limitations of temporary vascular occlusion during aneurysm surgery as evidenced by the postoperative ischemic symptoms in relation to cerebral blood flow were studied. Six of the 39 cases had postoperative ischemic neurological deficit. When residual cerebral blood flow was below 15 mL/min/100 g, transient symptoms were seen when temporary clipping was for 10–20 minutes. When more than 20 minutes of clipping was required, irreversible deficits were found. Correlations between residual cerebral blood flow, duration of temporary clipping, and postoperative ischemic symptoms were found. The monitoring of cortical cerebral blood flow is an effective means for determining the limits of temporary vascular occlusion. 相似文献
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Haruto Uchino Ken Kazumata Masaki Ito Naoki Nakayama Satoshi Kuroda Kiyohiro Houkin 《Acta neurochirurgica》2014,156(9):1753-1760