Chen S F, Kato Y, Oda J, Kumar A, Watabe T, Imizu S, Oguri D, Sano H, Hirose Y
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Surg Neurol Int. 2011 Mar 31;2:42. doi: 10.4103/2152-7806.78517.
To evaluate the usefulness and limitations of the intraoperative near-infrared (NIR) indocyanine green videoangiography (ICG-VA) and analysis of fluorescence intensity in cerebrovascular surgery.
Forty-eight patients received ICG-VA during various surgical procedures from May 2010 to August 2010. Included among them were 45 cases of cerebral aneurysms and 3 cases of cerebral arteriovenous malformations (AVMs). The infrared fluorescence module integrated into the surgical microscope was used to visualize fluorescent areas in the surgical field. An integrated analytical visualization tool constantly analyzed the fluorescence video sequence and generated it in the form of an intensity diagram for objective interpretation.
Overall, the procedure of ICG VA was done 158 times in 48 patients. There was no adverse effect of ICG dye. In cerebral aneurysm cases, the images obtained were of high resolution. In 4 cases, incomplete clipping was detected by ICG-VA and allowed suitable adjustment to completely obliterate the aneurysm. In 3 aneurysm cases, the intensity diagram of ICG VA provided valuable information. ICG-VA identified the feeding arteries, the draining veins, and nidus in all 3 AVM cases, which was confirmed by an immediate analysis of fluorescence intensity.
ICG-VA provides high resolution images allowing real-time assessment of the blood flow in surgical field. The intensity analysis function, in addition, is a useful adjunct to improve the accuracy of the clipping and decrease the complication rates in cerebral aneurysm cases. In cerebral AVM cases, with the help of color map and intensity diagram function, the superficial feeders, drainers, and nidus can be identified easily.
评估术中近红外（NIR）吲哚菁绿血管造影术（ICG-VA）及其荧光强度分析在脑血管手术中的实用性和局限性。
2010年5月至2010年8月期间，48例患者在各种手术过程中接受了ICG-VA检查。其中包括45例脑动脉瘤和3例脑动静脉畸形（AVM）。集成在手术显微镜中的红外荧光模块用于可视化手术视野中的荧光区域。一个集成的分析可视化工具不断分析荧光视频序列，并以强度图的形式生成，以便进行客观解释。
总体而言，48例患者共进行了158次ICG VA检查。ICG染料没有不良反应。在脑动脉瘤病例中，获得的图像具有高分辨率。在4例病例中，ICG-VA检测到夹闭不完全，并进行了适当调整以完全闭塞动脉瘤。在3例动脉瘤病例中，ICG VA的强度图提供了有价值的信息。ICG-VA在所有3例AVM病例中均识别出供血动脉、引流静脉和畸形血管团，荧光强度的即时分析证实了这一点。
ICG-VA提供高分辨率图像，可实时评估手术视野中的血流情况。此外，强度分析功能有助于提高脑动脉瘤夹闭的准确性并降低并发症发生率。在脑AVM病例中，借助彩色图谱和强度图功能，可以轻松识别浅表供血动脉、引流静脉和畸形血管团。
