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.

Application of indocyanine green angiography in surgery for giant intracranial aneurysm

Objective To explore the role of intraoperative indocyanine green angiography (ICGA) in the surgery of giant intracranial aneurysm (GIA). Methods Fifty-seven patients, admitted to our hospital from March 2007 to October 2009 and performed GIA clipping and/or resection, were chosen in this study. Intraoperative ICGA was performed using a surgical microscope with integrated ICGA technology before and after GIA clipping. The presence and patency of the parent artery and perforating artery around the aneurysms, and the information of aneurysm were analyzed in the mierosurgical field during surgical dissection and clip application. Assessment of vascular patency and occlusion of aneurysm after clipping was also investigated by DSA or CTA. These findings of ICGA were compared with those of postoperative DSA. Results A total of 128 investigations were performed in these 57 patients, and 61 aneurysms were clipped and removed. ICGA could provide real-time information about the circulation of the operating field and the patency of parent, branching and perforating arteries,and the aneurysm sac. Four out of the 57 patients were noted as having significantly changed information provided by intraoperative ICGA; after adjusting the aneurysm clipping, no such unexpected findings as parent or branching artery occlusion, or aneurysm sac omission were found on postoperative angiograms;the postoperative DSA results were consistent with the intraoperative ICGA findings. Conclusion ICGA is a technique of confirming the relationship between GIA and its surrounding arteries, and monitoring aneurysm residual, parent artery stenosis and vascular anastomotic patency during the surgery.