Neurosurgery, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy.
World Neurosurg. 2011 Jan;75(1):122-5. doi: 10.1016/j.wneu.2010.09.011.
As a general principle, sacrifice of cerebral veins at surgery is avoided. However, at times sacrifice of a vein may be desirable to increase surgical exposure. At present, no method exists to predict whether such sacrifice will be accommodated by the presence of collateral venous drainage. We show a simple technique to examine cerebral venous blood flow using indocyanine green videoangiography.
In two patients, parasagittal meningiomas were found to be associated with paramedian veins that impeded complete removal of the tumors. The suitability of veins removal was assessed by applying a temporary aneurysm clip and performing an indocyanine green videoangiogram.
In one patient, stasis was observed in the vein. In the second patient, a collateral flow allowed the venous blood to drain. The former test was considered a counterindication for venous sacrifice, whereas the latter supported its feasibility. The vein was preserved in the former case and coagulated in the latter. In both cases, the patients did well.
Although our limited study cannot prove that venous congestion or infarction can be avoided with this technique, it does provide direct evidence of the presence or absence of collaterals that can help guide intraoperative surgical decision-making.
一般来说，手术中避免牺牲脑静脉。然而，有时牺牲一条静脉可能有助于增加手术显露。目前，尚无方法可以预测这种牺牲是否会因存在侧支静脉引流而得到代偿。我们展示了一种使用吲哚菁绿视频血管造影检查脑静脉血流的简单技术。
在两名患者中，矢状窦旁脑膜瘤与旁正中静脉相关，这些静脉阻碍了肿瘤的完全切除。通过应用临时动脉瘤夹并进行吲哚菁绿视频血管造影来评估静脉切除的适宜性。
在一名患者中，观察到静脉内有停滞。在另一名患者中，侧支血流允许静脉血液排出。前者试验被认为是静脉牺牲的禁忌症，而后者则支持其可行性。在前者的情况下保留了静脉，在后者的情况下进行了凝固。在两种情况下，患者都恢复良好。
尽管我们的有限研究不能证明该技术可以避免静脉充血或梗塞，但它确实提供了存在或不存在侧支循环的直接证据，这有助于指导术中手术决策。
