Raabe Andreas, Beck Jürgen, Gerlach Rüdiger, Zimmermann Michael, Seifert Volker
Department of Neurosurgery, Neurocenter, Johann Wolfgang Goethe University Frankfurt am Main, Frankfurt am Main, Germany.
Neurosurgery. 2003 Jan;52(1):132-9; discussion 139. doi: 10.1097/00006123-200301000-00017.
We report our initial clinical experience with a new method for intraoperative blood flow assessment. The purposes of the study were to assess the use of indocyanine green (ICG) video angiography in neurovascular cases, to assess the handling and image quality, to compare the findings with postoperative angiographic results, and to evaluate the clinical value of the method in a preliminary feasibility study.
Fourteen patients with aneurysms (n = 12) or spinal (n = 1) or intracranial (n = 1) dural fistulae were included. Before and/or after aneurysm or dural fistula occlusion, ICG (25 mg) was injected intravenously. A near-infrared laser excitation light source (lambda = 780 nm) illuminated the operating field. The intravascular fluorescence of ICG (maximal lambda = 835 nm) was recorded by a nonintensified video camera, with optical filtering to block ambient and laser light for collection of only ICG-induced fluorescence.
A total of 21 investigations were performed for 14 patients. For the 17 successful ICG video angiographic investigations, image quality and resolution were excellent, allowing intraoperative real-time assessment of the cerebral circulation. ICG angiographic results could be divided into arterial, capillary, and venous phases, comparable to those observed with digital subtraction angiography. In all cases, the postoperative angiographic results corresponded to the intraoperative ICG video angiographic findings. In three cases, the information provided by intraoperative ICG angiography significantly changed the surgical procedure.
ICG video angiography is simple and provides real-time information on the patency of arterial and venous vessels of all relevant diameters, including small and perforating arteries (<0.5 mm), and the visible aneurysm sac. It may be a useful adjunct to improve the quality of neurovascular procedures and to document the intraoperative vascular flow.
我们报告一种术中血流评估新方法的初步临床经验。本研究的目的是评估吲哚菁绿（ICG）视频血管造影在神经血管病例中的应用，评估其操作及图像质量，将结果与术后血管造影结果进行比较，并在一项初步可行性研究中评估该方法的临床价值。
纳入14例患有动脉瘤（n = 12）或脊柱（n = 1）或颅内（n = 1）硬脑膜瘘的患者。在动脉瘤或硬脑膜瘘闭塞之前和/或之后，静脉注射ICG（25 mg）。近红外激光激发光源（波长 = 780 nm）照亮手术区域。通过非增强型摄像机记录ICG的血管内荧光（最大波长 = 835 nm），采用光学滤光片阻挡环境光和激光，仅收集ICG诱导的荧光。
对14例患者共进行了21次检查。在17次成功的ICG视频血管造影检查中，图像质量和分辨率极佳，可在术中实时评估脑循环。ICG血管造影结果可分为动脉期、毛细血管期和静脉期，与数字减影血管造影观察到的结果相似。在所有病例中，术后血管造影结果与术中ICG视频血管造影结果相符。在3例病例中，术中ICG血管造影提供的信息显著改变了手术操作。
ICG视频血管造影操作简单，可提供所有相关直径的动脉和静脉血管通畅情况的实时信息，包括小动脉和穿支动脉（<0.5 mm）以及可见的动脉瘤囊。它可能是提高神经血管手术质量和记录术中血管血流的有用辅助手段。
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