荧光造影和脑电监测在术中闭塞载瘤动脉时的作用

目的 探讨术中脑电图(EEG)监测和吲哚菁绿(ICG)血管荧光造影在颅内动脉瘤术中闭塞载瘤动脉时的作用.方法 2008年5月至11月,5例颅内动脉瘤患者术中遭遇载瘤动脉闭塞或拟牺牲载瘤动脉,2例只应用了EEG监测,1例只应用了术中ICG脑咀管荧光造影,2例同时应用了EEG监测和术中ICG脑血管荧光造影,对牺牲载瘤动脉的安全性进行评价.结果 1例术中EEG监测提示脑侧枝循环不良者行脑血管重建;1例闭塞载瘤动脉者,术中ICG脑血管造影提示侧枝循环不良,术后出现了脑缺血并发症;3例EEG监测和(或)ICG脑血管荧光造影提示侧枝循环良好者,单纯行闭塞载瘤动脉,术后无相应脑缺血后遗症.结论 术中EEG监测和ICG脑血管荧光造影可以作为术中闭塞载瘤动脉安全性的评价手段,联合应用更有价值.

Efficacy of intraoperative electroencephalography monitoring and indocyanine green angiography to assess the safety of parent artery sacrifice

Objective To explore the efficacy of intraoperative electroencephalography (EEG) monitoring and indocyanine green (ICG) angiography to assess the safety of parent artery sacrifice in intracranial aneurysm surgery.Methods From May to November 2008,intraoperative EEG monitoring and/or ICG angiography were used to assess the safety of sacrificing the parent artery in five patients.Intraoperative EEG monitoring was used in two patients,ICG angiography in one,both intraoperative EEG monitoring and ICG angiography in two.Results One patient with poor cerebral collateral circulation evaluated by intraoperative EEG monitoring underwent cerebral revaseularization.The other one with poor cerebral collateral circulation evaluated by ICG angiography underwent parent artery sacrifice only and tolerated the iatrogenie isehemia postoperatively.Three patients underwent permanent occlusion of parent artery had no isehemie complication postoperatively,in which intraoperative EEG monitoring and/or ICG angiography demonstrated sufficient collateral blood flow.Conclusion Intraoperative EEG monitoring and ICG angiography can be used during intracranial aneurysm surgery to determine patients' ability to tolerate permanent oeclusion of parent artery,combination of them may be more effective.