The Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, Sydney, NSW 2109, Australia.
The Australian School of Advanced Medicine, 2 Technology Place, Macquarie University, Sydney, NSW 2109, Australia.
J Clin Neurosci. 2014 Jan;21(1):67-72. doi: 10.1016/j.jocn.2013.04.002. Epub 2013 Oct 1.
Microscope-integrated near-infrared indocyanine green videoangiography (ICGVA) has been shown to be a useful adjunct for intracranial aneurysm surgery. That the routine application of this technique reduces the risk of postoperative ischaemic complication, however, has not been reported. We present a retrospective matched-pair comparison of ICGVA guided aneurysm surgery versus historic control surgical cohort treated by the same author. Index patients and controls were matched for aneurysm size, location, patient demographics, risk factors, comorbidities, and surgical treatments. Ninety-one eligible patients with 100 intracranial aneurysms were treated using ICGVA assistance. There were no statistically significant differences between the two groups in terms of patient age, sex, risk factors, comorbidities and aneurysm characteristics. Of the 100 aneurysms in the ICGVA group, 107 investigations of ICGVA were performed. In 79 aneurysms (79.0%), ICGVA was considered useful but did not affect surgical management. In six patients (6.0%), ICGVA led to a crucial change of intraoperative strategies. In nine patients (9.0%), it was considered critical in assuring patency of small perforators. ICGVA was of no benefit in four patients (4.0%) and was misleading in two (2.0%). Postoperative ischaemic complications occurred in three patients (3.3%) in the ICGVA group compared with seven patients (7.7%) in the control group (p<0.001). Our study supports the use of ICGVA in aneurysm surgery as a safe and effective modality of intraoperative blood flow assessment. With all limitations of a retrospective matched-pair comparison, the use of ICGVA during routine aneurysm surgery reduces the incidence of postoperative ischaemic complications.
显微镜集成近红外吲哚菁绿视频血管造影（ICGVA）已被证明是颅内动脉瘤手术的有用辅助手段。然而，常规应用该技术是否能降低术后缺血性并发症的风险尚未有报道。我们回顾性地比较了应用 ICGVA 指导的动脉瘤手术与接受同一术者治疗的历史对照手术队列。指数患者和对照组在动脉瘤大小、位置、患者人口统计学、危险因素、合并症和手术治疗方面进行了匹配。91 名符合条件的患者（100 个颅内动脉瘤）接受了 ICGVA 辅助治疗。两组患者在年龄、性别、危险因素、合并症和动脉瘤特征方面无统计学差异。在 ICGVA 组的 100 个动脉瘤中，进行了 107 次 ICGVA 检查。在 79 个动脉瘤（79.0%）中，ICGVA 被认为是有用的，但并未影响手术管理。在 6 名患者（6.0%）中，ICGVA 导致术中策略发生了关键变化。在 9 名患者（9.0%）中，ICGVA 对于确保小穿支通畅至关重要。在 4 名患者（4.0%）中，ICGVA 无益，在 2 名患者（2.0%）中，ICGVA 被认为具有误导性。在 ICGVA 组的 3 名患者（3.3%）和对照组的 7 名患者（7.7%）中发生了术后缺血性并发症（p<0.001）。我们的研究支持在动脉瘤手术中使用 ICGVA 作为一种安全有效的术中血流评估方法。尽管存在回顾性配对比较的所有局限性，但在常规动脉瘤手术中使用 ICGVA 可降低术后缺血性并发症的发生率。
