Clinical Department of Neurosurgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Austria.
Neurosurgery. 2012 Dec;71(2 Suppl Operative):ons260-7; discussion ons267-8. doi: 10.1227/NEU.0b013e318265a3fb.
Acute neurological deficits after subarachnoid hemorrhage (SAH) correlate with outcome, and a phase of acute hypoperfusion was characterized recently. Indocyanine green (ICG) videography is an established intraoperative imaging technique with important descriptive potential.
To analyze whether ICG can be used to analyze and confirm perfusion changes early after SAH.
We prospectively enrolled 11 patients with acute SAH within the past 24 hours and 14 patients undergoing surgery for unruptured aneurysms. Cortical ICG videography was performed, and offline analysis included the arterial, parenchymal, and venous cortical compartment. Transit times, signal gradient, maximum of fluorescence intensity, and the area under the curve were calculated as surrogate markers for perfusion characteristics.
Arterial, parenchymal, and venous transit times were comparable in both groups. The velocity of signal change in SAH patients was significantly lower in all 3 compartments (P < .001, P < .01, P < .001, respectively), as was the peak fluorescence intensity (P < .001). In SAH patients, fluorescence intensity did not vary between areas with and without diffuse cortical blood. Area under the curve analysis showed significantly lower values in SAH patients compared with the control group (P < .001).
Cortical ICG videography and analysis are feasible during surgery. Patients early after SAH have a significantly lower velocity of signal change, lower peak of fluorescence intensity, and lower overall area under the curve, but similar transit times. This technique can be used to quantify perfusion alteration, in this case, acute SAH, and may be used as an adapted measurement tool for intraoperative therapy.
蛛网膜下腔出血 (SAH) 后的急性神经功能缺损与预后相关，最近描述了一个急性低灌注期。吲哚菁绿 (ICG) 视频造影是一种成熟的术中成像技术，具有重要的描述潜力。
分析 ICG 是否可用于分析和确认 SAH 后早期的灌注变化。
我们前瞻性纳入了 11 例发病 24 小时内的急性 SAH 患者和 14 例接受未破裂动脉瘤手术的患者。进行皮质 ICG 视频造影，离线分析包括动脉、实质和静脉皮质区。通过计算渡越时间、信号梯度、荧光强度最大值和曲线下面积，作为灌注特征的替代标志物。
两组患者的动脉、实质和静脉渡越时间相似。SAH 患者在所有 3 个区域的信号变化速度均明显较低（分别为 P <.001、P <.01 和 P <.001），峰值荧光强度也较低（P <.001）。在 SAH 患者中，弥漫性皮质血区和无弥漫性皮质血区的荧光强度无差异。曲线下面积分析显示，SAH 患者的曲线下面积明显低于对照组（P <.001）。
皮质 ICG 视频造影和分析在手术中是可行的。SAH 后早期患者的信号变化速度明显较低、荧光强度峰值较低、整体曲线下面积较低，但渡越时间相似。该技术可用于定量灌注改变，在这种情况下，急性 SAH 可能作为术中治疗的一种适应测量工具。
