选择性吲哚氰绿荧光显影技术在颅颈交界区硬膜动静脉瘘手术中的作用

目的探讨应用选择性吲哚氰绿荧光显影技术在颅颈交界区硬膜动静脉瘘手术中的作用。方法回顾性分析2014年6月至2017年1月首都医科大学宣武医院治疗的24例(26侧)颅颈交界区硬膜动静脉瘘患者的临床资料,其中15例表现为蛛网膜下腔出血,8例为静脉高压性脊髓损伤症状,1例为延髓受压症状。术中应用选择性吲哚氰绿荧光显影技术,即暂时夹闭动脉化引流静脉的起始部,在吲哚氰绿荧光显影动脉期后开放引流静脉,从而判定动静脉瘘口位置。术后复查DSA,并以改良Rankin量表(mRS)评价临床疗效。结果 24例患者26侧的硬膜动静脉瘘均经术中瘘口离断,术中吲哚氰绿荧光显影及术后DSA随访证实瘘口均离断。术后随访时间4~30个月,21例患者mRs评分0~1分,2例Hunt-HessⅢ级蛛网膜下腔出血mRs评分2分,1例术前脑干受压症状患者mRs评分3分。结论选择性吲哚氰绿荧光显影技术是手术治疗颅颈交界区硬膜动静脉瘘寻找瘘口的一项安全、简便、有效的技术。

Effect of selective indocyanine green videoangiography in the operation of craniocervical junction dural arteriovenous fistulas

Objective To investigate the effect of using selective indocyanine green videoangiography in the surgical treatment of craniocervical junction dural arteriovenous fistulas.Methods From June 2014to January 2017,the clinical data of 24 patients (26 sides) with craniocervical junction dural arteriovenous fistula treated at the Department of Neurosurgery,Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 15 with subarachnoid hemorrhage,8 with venous hypertensive myelopathy,and 1 with medullary compression symptom.The selective indocyanine green fluorescence technique was used to temporarily clip the origin of the arterilized draining vein,and the drainage vein was opened after the indocyanine green fluorescent arterial phase,and thus to determine the sites of arteriovenous fistulas.DSA examination was performed again after the operation,and the clinical efficacy was evaluated with the modified Rankin scale (mRS).Results The dural arteriovenous fistulas of 24 patients (26 sides) were separated from the fistulas during the operation.Intraoperative indocyanine green fluorescence development and postoperative DSA follow-up confirmed that the fistulas were separated.The follow-up time was 4-30 months.The mRS score in 21 patients was 0-1,the Hunt-Hess grade Ⅲ subarachnoid hemorrhage in 2 patients was mRS score 2,and mRS score in 1 patients with preoperative brainstem compression symptom was mRS score 3.Conclusion The selective indocyanine green fluorescence technique is a safe,simple,and effective technique for the treatment of dural arteriovenous fistulas at the junction of craniocervical junction.