吲哚箐绿血管造影在颅内动脉瘤夹闭术中的应用价值

目的 探讨吲哚箐绿(Indocyanine green,ICG)血管造影在颅内动脉瘤夹闭术中的应用价值,以提高手术疗效.方法 32例35个颅内动脉瘤采取开颅动脉瘤夹闭术,夹闭前后均行吲哚箐绿血管造影,根据造影结果所示,如瘤颈有残留、载瘤动脉及其远端分支有狭窄则及时调整动脉瘤夹,如术野区其它血管有痉挛变细情况则采用罂粟碱浸泡,28例术后复查CT、3D-CTA或DSA以判断有无脑梗死及动脉瘤夹闭情况.结果 术中发现动脉瘤残颈3例,载瘤动脉狭窄4例,远端分支狭窄2例,术野区动脉痉挛变细4例,侧裂静脉变细3例.本组死亡2例.术后3D-CTA或DSA见动脉瘤夹闲完全,载瘤动脉通畅,与术中ICG造影显像一致,CT示小面积脑梗死3例.结论 术中吲哚箐绿血管造影对于判断动脉瘤颈是否夹闭完全、载瘤动脉及其远端分支有无狭窄以及术野区其它血管有无痉挛变细有重要价值,可提高手术疗效.

Significance of intraoperative indocyanine green angiography during microsurgical treatment of intracranial aneurysm.

Objective To investigate the significance of intraoperative indocyanine green(ICG) angiography during microsurgical treatment of intracranial aneurysm and improve the curative effect. MethodsThe clinical materials of 32 patients harboring 35 intracranial aneurysms were retrospectively analyzed.The intraoperative ICG angiography was performed before and after the clipping of aneurysm.According to the findings of ICG angiography,the clip was adjusted if necessary and when spasmodic vessels occur on operative area the papaverine hydrochloride soaked on.Postoperatively,CT scan identifies whether there was infarction and 3D-CTA or DSA confirm the complete aneurysm obliteration in 28 cases. ResultsDuring the microsurgical procedure,aneurysmal neck remnant was found in 3 cases,parent arteries stenosis in 4 cases,distal branch stenosis in 2 cases,spasmodic vessels in 7 cases.The clips were immediately adjusted until satisfactory blood flow was restored and papaverine hydrochloride was used on the operative areas.There were death due to cerebral heriation and multiple organ failure in 2 cases.Postoperative CT,3D-CTA or DSA in 28 cases found complete clipping of aneurysms,no parent arteries and distal branch stenosis,small area infarction in 3 cases. Conclusion ICG angiography could be used to judge whether the aneurysm is completely obliterated,the parent and distal artery is stenosis.This technique could aid in improvement of outcome for the patients with intracranial aneurysm.