Woitzik Johannes, Peña-Tapia Pablo G, Schneider Ulf C, Vajkoczy Peter, Thomé Claudius
Department of Neurosurgery, University Hospital Mannheim, Faculty of Clinical Medicine, Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
Stroke. 2006 Jun;37(6):1549-51. doi: 10.1161/01.STR.0000221671.94521.51. Epub 2006 Apr 27.
Assessment of cerebral perfusion during neurosurgical procedures would be beneficial to identify areas at risk and to guide placement of monitoring probes. Therefore, we have adapted near-infrared indocyanine-green (ICG) videoangiography to assess cortical perfusion intraoperatively.
ICG videoangiography was performed intraoperatively in 6 patients after decompressive hemicraniectomy for middle cerebral artery stroke. Flow maps of cortical perfusion were generated with IC-CALC 1.1 software by calculating the ratio of difference in fluorescence intensity and rise time.
Excellent visualization of cerebral arteries, cortical perfusion and collateral circulation via leptomeningeal anastomoses could be demonstrated in all cases. Flow maps revealed high spatial resolution and showed heterogeneous maple-leaf-shaped hypoperfusion. 26.5+/-13.7% and 29.0+/-9.1% of the exposed cortical surface (141+/-18 cm2) demonstrated core and penumbral flow, respectively.
ICG videoangiography appears to be a valuable tool to precisely detect relative cortical tissue perfusion. Thus, it may provide useful research data on the pathophysiology of human stroke, help surgeons to maintain adequate brain perfusion intraoperatively, and simplify adequate placement of tissue probes to monitor critically hypoperfused brain tissue.
在神经外科手术过程中评估脑灌注，对于识别风险区域以及指导监测探头的放置具有重要意义。因此，我们采用近红外吲哚菁绿（ICG）视频血管造影术在术中评估皮质灌注。
对6例因大脑中动脉卒中行减压性颅骨切除术的患者在术中进行ICG视频血管造影。使用IC-CALC 1.1软件通过计算荧光强度差异与上升时间的比值生成皮质灌注血流图。
所有病例均能清晰显示脑动脉、皮质灌注以及通过软脑膜吻合的侧支循环。血流图显示出高空间分辨率，并呈现出异质性的枫叶状灌注不足。暴露的皮质表面（141±18平方厘米）分别有26.5±13.7%和29.0±9.1%显示为核心血流和半暗带血流。
ICG视频血管造影似乎是精确检测相对皮质组织灌注的一种有价值的工具。因此，它可能为人类卒中的病理生理学提供有用的研究数据，帮助外科医生在术中维持足够的脑灌注，并简化组织探头的合理放置以监测严重灌注不足的脑组织。
