Mielke Dorothee, Malinova Vesna, Rohde Veit
Department of Neurosurgery, Georg-August-University Göttingen, Göttingen, Germany.
Neurosurgery. 2014 Sep;10 Suppl 3:418-25; discussion 425. doi: 10.1227/NEU.0000000000000345.
Indocyanine green (ICG) angiography is used to detect vessel compromise by the clip, residual aneurysms after clipping, or persistent aneurysm filling due to incomplete clipping. For ICG angiography, the microscope must be in a direct line-of-sight with the region of interest, limiting the identification of hidden arteries and dog-ear remnants.
To use a prototype endoscope for visualization of ICG fluorescence in hidden regions of the microsurgical field and evaluate its potential usefulness compared with microscopic ICG angiography (m-ICG-A) in a consecutive series of 30 aneurysms in 26 patients.
In selected cases, before and routinely after microsurgical clip application, m-ICG-A and endoscopic ICG angiography (e-ICG-A) were performed. The information gained by m-ICG-A was compared with that gained by e-ICG-A.
E-ICG-A was technically feasible in all operations. Intra-arterial fluorescence could be visualized up to 10 times longer with the endoscope than with the microscope. The endoscope allowed a closer view on the fluorescent artery-aneurysm-complex. e-ICG-A provided more information than m-ICG-A in 11 operations (confirmation of unhindered blood flow in microscopically hidden vessels [n = 6], neck remnant identification [n = 2], neck remnant exclusion [n = 2], blood flow control in 2 distant clipped aneurysms [n = 1]). In 14 operations, identical information was obtained, and in 1 operation e-ICG-A was inferior because of trapped intra-aneurysmal fluorescence.
In selected cases, e-ICG-A provides the neurosurgeon with information that cannot be obtained by m-ICG-A. e-ICG-A is capable of emerging as a useful adjunct in aneurysm surgery and has the potential to further improve operative results.
吲哚菁绿（ICG）血管造影用于检测夹子导致的血管损伤、夹闭术后残留动脉瘤或夹闭不完全导致的动脉瘤持续充盈。对于ICG血管造影，显微镜必须与感兴趣区域处于直接视线范围内，这限制了对隐藏动脉和“狗耳”残余物的识别。
使用一种原型内窥镜观察显微手术视野中隐藏区域的ICG荧光，并在26例患者连续30个动脉瘤的系列研究中，与显微ICG血管造影（m-ICG-A）相比评估其潜在用途。
在选定病例中，在显微手术夹应用前和常规应用后，分别进行m-ICG-A和内窥镜ICG血管造影（e-ICG-A）。将m-ICG-A获得的信息与e-ICG-A获得的信息进行比较。
e-ICG-A在所有手术中技术上都是可行的。内窥镜观察动脉内荧光的时间比显微镜长10倍。内窥镜能够更近距离观察荧光动脉-动脉瘤复合体。在11例手术中，e-ICG-A提供的信息比m-ICG-A更多（证实显微镜下隐藏血管的血流未受阻碍[n = 6]、识别颈部残余物[n = 2]、排除颈部残余物[n = 2]、控制2个远处夹闭动脉瘤的血流[n = 1]）。在14例手术中，获得了相同的信息，在1例手术中，由于动脉瘤内荧光被困，e-ICG-A较差。
在选定病例中，e-ICG-A为神经外科医生提供了m-ICG-A无法获得的信息。e-ICG-A有潜力成为动脉瘤手术中有用的辅助手段，并有可能进一步改善手术效果。
