Goodman Campbell Brain and Spine, Indiana University Department of Neurological Surgery, Indianapolis, Indiana.
Neurosurg Focus. 2014 Feb;36(2):E15. doi: 10.3171/2013.11.FOCUS13483.
The authors report on the use of a recently developed microscope-integrated fluorescent module using low-dose intravenous fluorescein for videoangiography during arteriovenous malformation (AVM) surgery.
The authors analyzed the application of a low-dose intraoperative fluorescein in 4 consecutive patients undergoing AVM surgery. The ability to distinguish the associated vessels of the AVM from normal vessels and to assess the degree of AVM obliteration based on videoangiography of venous drainage was specifically analyzed.
All 4 patients underwent fluorescein angiography without complication. In each case, videoangiography confirmed recognition of feeding arteries and draining veins through the operating oculars under the fluorescent mode. In one case involving a large frontal AVM, videoangiography demonstrated mainly cortical veins on the surface of the AVM and alerted the senior author to first tackle the feeding arteries in the interhemispheric space. While evaluating the flow within the different draining veins after most of the AVM was disconnected, videoangiography also prioritized the order for disconnection of large draining veins to allow mobilization the AVM and exposure of the remaining deep arterial feeders. In the other 3 cases, videoangiography allowed easy recognition of the angioarchitecture of the AVMs, estimated its cortical boundaries, and most importantly, assessed the flow within the draining veins before their disconnection.
The authors found fluorescein videoangiography to be a useful adjunct in resection of AVMs. This technology offers the unique ability to visualize fluorescent vessels and nonfluorescent tissues in near-natural colors simultaneously and permits microsurgical manipulation of relevant structures under the fluorescent mode. Larger-scale studies are needed to establish its efficacy and wider applicability.
作者报告了一种最近开发的显微镜集成荧光模块的使用情况，该模块使用低剂量静脉内荧光素进行动静脉畸形（AVM）手术中的视频血管造影。
作者分析了在 4 例连续接受 AVM 手术的患者中应用低剂量术中荧光素的情况。特别分析了根据静脉引流的视频血管造影来区分 AVM 的相关血管与正常血管的能力，以及评估 AVM 闭塞程度的能力。
所有 4 例患者均无并发症行荧光素血管造影。在每种情况下，荧光模式下的视频血管造影均确认了通过手术目镜识别供血动脉和引流静脉。在一例涉及大型额 AVM 的病例中，视频血管造影显示 AVM 表面主要为皮质静脉，并提醒高级作者首先处理大脑间空间的供血动脉。在评估大部分 AVM 断开后不同引流静脉内的血流时，视频血管造影还确定了大引流静脉断开的顺序，以允许移动 AVM 并暴露剩余的深部动脉供血者。在另外 3 例中，视频血管造影可轻松识别 AVM 的血管结构，估计其皮质边界，最重要的是，在断开引流静脉之前评估其血流。
作者发现荧光素视频血管造影在 AVM 切除中是一种有用的辅助手段。该技术具有独特的能力，可同时可视化荧光血管和非荧光组织，并在荧光模式下允许对相关结构进行显微手术操作。需要更大规模的研究来确定其疗效和更广泛的适用性。
