Balamurugan S, Agrawal Abhishek, Kato Yoko, Sano Hirotoshi
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
Asian J Neurosurg. 2011 Jul;6(2):88-93. doi: 10.4103/1793-5482.92168.
Microscope integrated Near infra red Indocyanine green video angiography (NIR ICG VA) has been frequently used in cerebrovascular surgery. It is believed to be a simple and reliable method with acquisition of real time high spatial resolution images. The aim of this review article was to evaluate the efficacy of intra operative Indocyanine green video angiography (ICG VA) in Aneurysm, brain arteriovenous malformations (AVM) and extracranial-intracranial (EC-IC) bypass surgeries and also to analyze its limitations. Intra operative imaging is a very useful tool in guiding surgery; thus, avoiding surgical morbidity. Now-a-days, many cerebrovascular units are using ICG VA rather than Doppler and intra operative DSA in most of their aneurysm surgeries, and surgeons are incorporating this technique for AVM and in EC-IC bypass surgeries too. This article is an overview of the beneficial effects of ICG VA in cerebrovascular surgery and will also point out its limitations in various circumstances. Intra operative ICG VA gives high resolution, real time images of arterial, capillary, and venous flow of cerebral vasculature. Although it gives adequate information about the clipped neck, parent/branching artery and perforator involvement, it has some limitations like viewing the neck residuals located behind the aneurysm, thick walled atherosclerotic vessels, and thrombosed aneurysms. In AVM surgery, it is useful in detecting the residual nidus in diffuse type AVM, but cannot be relied in deep seated AVMs and it gives exact information about the anastomosis site in EC-IC bypass, thus, avoiding early bypass graft failure. NIR ICG VA is a simple, reliable, and quick method to pick up subtle findings in cerebrovascular procedures. But in selected cases of aneurysms, endoscopy and intra operative Digital substraction angiography (DSA) may be helpful, whereas in deep seated AVMs, navigation may be required as an adjunct to confirm intra operative findings.
显微镜集成近红外吲哚菁绿视频血管造影术（NIR ICG VA）已在脑血管手术中频繁使用。它被认为是一种简单可靠的方法，能够获取实时高空间分辨率图像。这篇综述文章的目的是评估术中吲哚菁绿视频血管造影术（ICG VA）在动脉瘤、脑动静脉畸形（AVM）和颅外-颅内（EC-IC）搭桥手术中的疗效，并分析其局限性。术中成像在指导手术方面是一种非常有用的工具，从而避免手术并发症。如今，许多脑血管科室在大多数动脉瘤手术中使用ICG VA而非多普勒和术中数字减影血管造影（DSA），并且外科医生在AVM手术和EC-IC搭桥手术中也采用了这种技术。本文概述了ICG VA在脑血管手术中的有益作用，同时也将指出其在各种情况下的局限性。术中ICG VA能提供脑血管系统动脉、毛细血管和静脉血流的高分辨率实时图像。尽管它能提供关于夹闭颈部、供血/分支动脉和穿支受累的充分信息，但它也有一些局限性，比如观察位于动脉瘤后方的颈部残余、厚壁动脉粥样硬化血管以及血栓形成的动脉瘤。在AVM手术中，它有助于检测弥漫型AVM中的残余病灶，但对于深部AVM则不可靠，并且它能提供关于EC-IC搭桥吻合部位的确切信息，从而避免早期搭桥移植失败。NIR ICG VA是一种在脑血管手术中发现细微病变的简单、可靠且快速的方法。但在某些特定的动脉瘤病例中，内镜检查和术中数字减影血管造影（DSA）可能会有所帮助，而在深部AVM中，可能需要导航作为辅助手段来确认术中发现。
