Ma Chi-Yuan, Shi Ji-Xin, Wang Han-Dong, Hang Chun-Hua, Cheng Hui-Lin, Wu Wei
Department of Neurosurery, Nanjing Jinling Hospital, Nanjing University, School of Medicine, 305 East Zhongshan Road, Nanjing 210002, China.
Clin Neurol Neurosurg. 2009 Dec;111(10):840-6. doi: 10.1016/j.clineuro.2009.08.017. Epub 2009 Sep 10.
The goal of this report is to illustrate the use of intraoperative indocyanine green (ICG) angiography in the surgical management of intracranial aneurysms, including microsurgical clipping and revascularization.
This study included a series of 45 patients who were surgically treated between June 2007 and May 2008 for intracranial aneurysms. Fourty-three of the patients had anterior circulation aneurysms, and 2 had posterior circulation aneurysms. Forty-one patients were treated with microsurgical clipping. Four patients underwent revascularization combined with aneurysm dissection or trapping. Intraoperative ICG angiography was used to visualize the aneurysm clipping, patency of parent artery or graft. The ICG angiography technique is described, with particular reference to evaluation of the aneurysm clipping and revascularization.
Eighty-nine ICG angiography procedures were performed in 45 patients with intracranial aneurysms. The aneurysms were completely obliterated for all patients, and the grafts were patented for all except 1 patient. Pre-clipping ICG angiography showed the relationship of aneurysm and its parent artery clearly. After aneurysms being clipped, intraoperative ICG angiography found remnant of aneurysms, stenosis or occlusion of parent arteries and grafts in 8 cases, which were revised in the same surgical procedure. The results of ICG angiography correlated well with postoperative DSA in 97% patients.
ICG angiography can provide real-time information and guide revision in the same surgical procedure for the management of intracranial aneurysms.
本报告的目的是阐述术中吲哚菁绿（ICG）血管造影在颅内动脉瘤手术治疗中的应用，包括显微手术夹闭和血管重建。
本研究纳入了2007年6月至2008年5月期间接受颅内动脉瘤手术治疗的45例患者。其中43例患者为前循环动脉瘤，2例为后循环动脉瘤。41例患者接受了显微手术夹闭。4例患者接受了血管重建联合动脉瘤解剖或包裹术。术中使用ICG血管造影来观察动脉瘤夹闭情况、载瘤动脉或移植物的通畅情况。描述了ICG血管造影技术，特别提及了对动脉瘤夹闭和血管重建的评估。
45例颅内动脉瘤患者共进行了89次ICG血管造影检查。所有患者的动脉瘤均完全闭塞，除1例患者外，所有移植物均通畅。夹闭前ICG血管造影清晰显示了动脉瘤与其载瘤动脉的关系。动脉瘤夹闭后，术中ICG血管造影发现8例存在动脉瘤残留、载瘤动脉或移植物狭窄或闭塞情况，并在同一手术过程中进行了修正。97%的患者ICG血管造影结果与术后数字减影血管造影（DSA）结果高度相关。
ICG血管造影可为颅内动脉瘤手术治疗提供实时信息并指导术中修正。
