Department of Neurosurgery, Thomas Jefferson University, and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania 19107, USA.
Neurosurgery. 2012 Dec;71(6):1162-9. doi: 10.1227/NEU.0b013e318271ebfc.
In an era of indocyanine angiography, the routine use of intraoperative angiography (IOA) in the surgical treatment of aneurysms and vascular malformations is controversial.
To retrospectively assess the safety and efficacy of IOA and to determine predictors of surgical revision.
Between 2003 and 2011, IOA was performed during surgical treatment of 976 aneurysms, 101 arteriovenous malformations (AVMs), and 16 arteriovenous fistulas.
In 80 of 976 aneurysms (8.2%), IOA prompted clip repositioning. The reason for readjustment was residual aneurysm in 54.7%, parent vessel occlusion in 42.9%, and both in 2.4% of cases. In multivariate analysis, increasing aneurysm size (P, .001), ruptured aneurysm (P, .001), and increasing number of vessels injected (P, .001) were strong predictors of clip readjustment. There was a strong trend for posterior circulation aneurysm location to predict clip repositioning (P = .06). IOA revealed residual nidus/ fistula requiring further intervention in 9 of 101 AVMs (8.9%) and 3 of 16 arteriovenous fistulas (18.8%). Of 9 AVMs requiring a surgical revision, 2 (22.2%) were Spetzler-Martin grade II, 5 (55.6%) were grade III, and 2 (22.2%) were grade IV. Mean Spetzler-Martin grade was 3.0 in AVMs requiring surgical revision compared with 2.3 in those not requiring revision (P = .05). IOA-related complications were all transient or minor and occurred in 0.99% of patients; none resulted in permanent morbidity.
IOA remains a valuable tool in the surgical treatment of brain vascular abnormalities, guiding surgical re-exploration in .8% of cases. Easy access to an angiographer and routine use of IOA are important factors contributing to procedural safety and efficacy.
在吲哚菁绿血管造影术的时代，术中血管造影（IOA）在动脉瘤和血管畸形的手术治疗中的常规应用仍存在争议。
回顾性评估 IOA 的安全性和有效性，并确定手术修正的预测因素。
在 2003 年至 2011 年间，对 976 个动脉瘤、101 个动静脉畸形（AVM）和 16 个动静脉瘘进行了手术治疗，术中均进行了 IOA。
在 976 个动脉瘤中，有 80 个（8.2%）因 IOA 提示夹闭调整。重新调整的原因分别是残留动脉瘤 54.7%，载瘤动脉闭塞 42.9%，两者均有 2.4%。多变量分析显示，动脉瘤大小增加（P，.001）、破裂的动脉瘤（P，.001）和注入的血管数量增加（P，.001）是夹闭调整的强烈预测因素。后循环动脉瘤的位置也有强烈的趋势提示夹闭调整（P=.06）。在 101 个 AVM 中有 9 个（8.9%）和 16 个动静脉瘘中有 3 个（18.8%）发现残留病灶/瘘管需要进一步干预。在需要手术修正的 9 个 AVM 中，2 个（22.2%）为 Spetzler-Martin 分级 II，5 个（55.6%）为分级 III，2 个（22.2%）为分级 IV。需要手术修正的 AVM 的平均 Spetzler-Martin 分级为 3.0，而不需要修正的 AVM 为 2.3（P=.05）。IOA 相关并发症均为一过性或轻微，发生率为 0.99%，无永久性并发症。
IOA 仍然是脑血管病变手术治疗的一种有价值的工具，指导 8%的病例进行手术再探查。易于获得血管造影师和常规使用 IOA 是保证手术安全性和有效性的重要因素。
