吲哚菁绿血管造影在颅内动脉瘤手术中的初步应用

目的探讨吲哚菁绿（indocyanine green，ICG）脑血管造影在颅内动脉瘤手术中的作用。方法选择20例术中行ICG造影的颅内动脉瘤患者，其中16例手术直接夹闭动脉瘤，1例手术切除动脉瘤，3例行动脉瘤切除或孤立＋血管重建术。术中造影时，将即时稀释的对比剂（25mg的ICG加入到2ml注射用水中）一次性快速注入肘静脉，荧光手术显微镜下观察造影血管。术后行DSA造影。评价术中ICG造影在颅内动脉瘤手术中的作用。结果16例行动脉瘤夹闭手术患者中，1例小脑下后动脉动脉瘤患者，夹闭后ICG造影发现动脉瘤残余，经调整动脉瘤夹后再次ICG造影，证实动脉瘤夹闭完全；1例颈内动脉动脉瘤夹闭后术中造影发现颈内动脉狭窄，调整动脉瘤夹后再次造影证实无狭窄。1例大脑后动脉瘤患者，术中ICG造影发现动脉瘤内完全血栓形成，载瘤动脉近端闭塞，远端通过血管吻合支供血，遂术中决定行动脉瘤切除术。3例动脉瘤切除或孤立＋血管重建手术患者中，2例术中ICG造影证实吻合口通畅，远端血供良好；1例术中造影发现吻合口功能不良，但同侧额叶脑组织供血良好，故未进一步调整吻合口，术后患者无明显神经功能缺损症状，DSA证实同侧大脑中动脉侧支供血。16例术后行DSA检查者，均证实术中ICG造影结果。结论ICG血管造影是颅内动脉瘤术中监测动脉瘤是否残留、载瘤动脉是否狭窄及吻合血管是否通畅的重要的手段。

Preliminary experience of indocyanine green angiography in intracranial aneurysm surgery

Objective To investigate the effect of using indocyanine green(ICG) angiography in intracranial aneurysm surgery.Methods Twenty patients with intracranial aneurysms who underwent intraoperative ICG angiography were selected.The aneurysms were directly clipped in 16 of them,one had aneurysmectomy,and 3 underwent aneurysmectomy or trapping revascularization.Sixteen patients underwent digital subtraction angiography(DSA) after surgery.The effect of intraoperative ICG angiography in intracranial aneurysm surgery was evaluated.Results Of the 16 patients who underwent aneurysm clipping,residual aneurysm was found by ICG angiography after the clipping in one patient with posterior inferior cerebellar artery aneurysm,after adjusting the aneurysm clip,ICG angiography demonstrated that the aneurysm was completely clipped.Internal carotid stenosis was found by intraoperative angiography after clipping of an ophthalmic artery aneurysm in one patient,after adjusting the aneurysm clip,ICG angiography demonstrated that there was no stenosis existed.Complete thrombosis of aneurysm was found by intraoperative ICG angiography in a patient with posterior cerebral artery aneurysm,the proximal parent artery of the aneurysm was already embolized,the distal blood supply was carried by collateral branches,and then aneurysmectomy was decided during the operation.Of the 3 patients who underwent aneurysmectomy or trapping revascularization,ICG angiography demonstrated that the anastomoses were patent in 2 patients,and their distal blood supply was sufficient.ICG angiography found that the anastomotic function was not favorable in one patient,but the blood supply of his temporal lobe was good,so the anastomosis was not adjusted further.The patient did not have significant neurological deficit after the procedure,and DSA demonstrated that collateral supply to the ipsilateral middle cerebral artery.The 16 patients examined with DSA after the procedures confirmed the results of intraoperative ICG angiography.Conclusion ICG angiography is an important means in monitoring aneurysm residual,parent artery stenosis and vascular anastomotic patency during intracranial aneurysm surgery.