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.

Study on the causes of "false - negative" in indocyanine green angiography during intracranial aneurysm surgery

Objective To explore the causes and treatment principles of the "false negative" phenomenon of intraoperative near infrared indocyanine green angiography (ICGA) during intracranial aneurysm surgery. Methods The causes of "false negative"and limitations of ICGA during aneurysm surgery were analysed and the related treatment principles were studied. Results Seven patients with intracranial aneurysm presented ICGA "false negative" during surgical clipping. When the aneurysm body was incised or stabbed errhysis may emerged. After immediately cleaned away the oozing of blood at the neck of aneurysm and regulated the clipping position of aneurysm, errhysis was eliminated. Conclusion Although ICGA is useful in determining the obliteration of aneurysm by surgical clipping, there are some limitations. Wide necked aneurysm, thrombosis on the neck of aneurysm or atheromatous plaque at the vessel wall and arachnoid incomplete seperated may induce ICGA "false negative". Therefore, when ICGA "false negative" occurs in surgical clipping of aneurysm other monitoring methods should be used to confirm the obliteration of aneurysm.