Zaidi Hasan A, Abla Adib A, Nakaji Peter, Chowdhry Shakeel A, Albuquerque Felipe C, Spetzler Robert F
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Neurosurgery. 2014 Jun;10 Suppl 2:246-51; discussion 251. doi: 10.1227/NEU.0000000000000318.
Indocyanine green (ICG) angiography is commonly used to map the vascular configuration of cerebral arteriovenous malformations (AVMs) during resection.
To determine whether ICG improves rates of resection and clinical outcomes.
A retrospective chart review was done for all patients undergoing resection of an AVM by the senior author (R.F.S.) between 2007 and 2011. Operative reports, hospital records, and radiographic imaging were used to determine the use of ICG, the incidence of residual disease, and clinical outcomes.
A total of 130 cases (56 ICG, 74 non-ICG) were identified. Average AVM grade (2.2 vs 2.4) and size (2.7 vs 2.7 cm) were similar between the ICG and non-ICG groups, respectively. ICG was more often used when the AVM nidus was close to the cortical surface (71.4% vs 17.6%; P = .001) or lobar (82.1% vs 54.1%; P = .008). Eighteen patients (13.8%) were noted to have residual disease. Reoperation rates and change in modified Rankin Scale score were not different between the 2 groups (12.5% vs 14.9%, P = .8; 0.6 vs 0.4, P = .17). There were no ICG-attributable complications.
ICG videoangiography is a quick and safe method of intraoperatively mapping the angioarchitecture of superficial AVMs, but it is less helpful for deep-seated lesions. This modality alone does not improve the identification of residual disease or clinical outcomes. Surgeon experience with extensive study of preoperative vascular imaging is paramount to achieving acceptable clinical outcomes. Formal angiography remains the gold standard for the evaluation of AVM obliteration.
吲哚菁绿（ICG）血管造影术常用于在脑动静脉畸形（AVM）切除术中描绘其血管结构。
确定ICG是否能提高切除率和临床疗效。
对2007年至2011年间由资深作者（R.F.S.）进行AVM切除术的所有患者进行回顾性病历审查。手术报告、医院记录和影像学检查用于确定ICG的使用情况、残留疾病的发生率和临床疗效。
共识别出130例病例（56例使用ICG，74例未使用ICG）。ICG组和非ICG组的平均AVM分级（分别为2.2和2.4）及大小（分别为2.7和2.7 cm）相似。当AVM病灶靠近皮质表面（71.4%对17.6%；P = 0.001）或位于脑叶（82.1%对54.1%；P = 0.008）时，ICG的使用更为频繁。18例患者（13.8%）被发现有残留疾病。两组的再次手术率和改良Rankin量表评分变化无差异（12.5%对14.9%，P = 0.8；0.6对0.4，P = 0.17）。没有ICG引起的并发症。
ICG视频血管造影术是一种快速、安全的术中描绘浅表AVM血管结构的方法，但对深部病变的帮助较小。单独使用这种方法并不能提高对残留疾病的识别或临床疗效。外科医生对术前血管成像进行广泛研究的经验对于获得可接受的临床疗效至关重要。正式血管造影术仍然是评估AVM闭塞的金标准。
