Murai Yasuo, Mizunari Takayuki, Koketsu Kenta, Tateyama Kojiro, Kobayashi Shiro, Umeoka Katsuya, Teramoto Akira, Morita Akio
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
Department of Neurosurgery, Nippon Medical School Chiba Hokuso Hospital, Chiba, Japan.
Clin Neurol Neurosurg. 2014 Apr;119:70-4. doi: 10.1016/j.clineuro.2014.01.015. Epub 2014 Jan 31.
To understand the relationship between the parent artery and its distal arteries, blood vessels running through the subarachnoid space need to be extensively dissected, which is time-consuming. We examined the efficacy of temporary clipping with the indocyanine green (ICG) technique (target-controlled infusion (TCI) technique), in which the parent artery is occluded using a temporary clip, and ICGV (videoangiography) is performed to clarify the relationship between the distal M4 and proximal M2.
Thirteen radial artery grafts (RAGs) for internal carotid aneurysm underwent TCI to confirm the relationship between M2 and cortical M4. To monitor the perfusion pressure of the cortical middle cerebral artery, superficial temporal artery (STA) to M4 anastomosis was performed before RA-M2 anastomosis. We performed anastomosis of the recipient of STA- M4 that was distal and downstream of the M2 segment that is the recipient of RA-M2 anastomosis. To select the proper recipient M4 of the STA-M4 anastomosis, the ICGV image range was set sufficiently wide to accommodate the possibility that the distal artery was not the one anticipated. ICGV followed complete occlusion by temporary clipping of the recipient M2.
In 2 of the 13 cases, the relationship between the M2 and M4 could not be clarified.
In cases with developed collateral circulation or small perfusion area of the occluded M2, it was difficult to ascertain the relationship by TCI. Nevertheless, TCI was useful in 11 of the 13 cases, suggesting that unnecessary dissection in the subarachnoid space may be reduced using this technique.
为了解大脑中动脉主干与其远端分支血管的关系，需要广泛解剖蛛网膜下腔内走行的血管，这一过程耗时较长。我们研究了采用吲哚菁绿（ICG）技术（靶控输注（TCI）技术）进行临时夹闭的效果，即使用临时夹夹闭大脑中动脉主干，然后进行吲哚菁绿视频血管造影（ICGV）以明确大脑中动脉M4段远端与M2段近端的关系。
对13例接受桡动脉移植治疗颈内动脉瘤的患者采用TCI技术来确认M2段与大脑皮质M4段之间的关系。为监测大脑皮质大脑中动脉的灌注压，在桡动脉与M2段吻合之前先进行颞浅动脉（STA）与M4段的吻合。我们将STA-M4吻合的受体设置在RA-M2吻合受体M2段的远端和下游。为选择合适的STA-M4吻合受体M4段，将ICGV图像范围设置得足够宽，以应对远端动脉并非预期动脉的可能性。在临时夹闭受体M2段使其完全闭塞后进行ICGV检查。
13例中有2例无法明确M2段与M4段之间的关系。
在侧支循环发达或闭塞的M2段灌注区域较小的情况下，难以通过TCI技术确定两者之间的关系。尽管如此，TCI技术在13例中有11例是有用的，这表明使用该技术可能减少在蛛网膜下腔内进行不必要的解剖。
