Kobayashi Shinya, Ishikawa Tatsuya, Tanabe Jun, Moroi Junta, Suzuki Akifumi
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-AKITA, Akita, Japan.
Surg Neurol Int. 2014 Sep 15;5:135. doi: 10.4103/2152-7806.140705. eCollection 2014.
Intraoperative qualitative indocyanine green (ICG) angiography has been used in cerebrovascular surgery. Hyperperfusion may lead to neurological complications after superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis. The purpose of this study is to quantitatively evaluate intraoperative cerebral perfusion using microscope-integrated dynamic ICG fluorescence analysis, and to assess whether this value predicts hyperperfusion syndrome (HPS) after STA-MCA anastomosis.
Ten patients undergoing STA-MCA anastomosis due to unilateral major cerebral artery occlusive disease were included. Ten patients with normal cerebral perfusion served as controls. The ICG transit curve from six regions of interest (ROIs) on the cortex, corresponding to ROIs on positron emission tomography (PET) study, was recorded. Maximum intensity (IMAX), cerebral blood flow index (CBFi), rise time (RT), and time to peak (TTP) were evaluated.
RT/TTP, but not IMAX or CBFi, could differentiate between control and study subjects. RT/TTP correlated (|r| = 0.534-0.807; P < 0.01) with mean transit time (MTT)/MTT ratio in the ipsilateral to contralateral hemisphere by PET study. Bland-Altman analysis showed a wide limit of agreement between RT and MTT and between TTP and MTT. The ratio of RT before and after bypass procedures was significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.60 ± 0.032 and 0.80 ± 0.056, respectively; P = 0.017). The ratio of TTP was also significantly lower in patients with postoperative HPS than in patients without postoperative HPS (0.64 ± 0.081 and 0.85 ± 0.095, respectively; P = 0.017).
Time-dependent intraoperative parameters from the ICG transit curve provide quantitative information regarding cerebral circulation time with quality and utility comparable to information obtained by PET. These parameters may help predict the occurrence of postoperative HPS.
术中定性吲哚菁绿（ICG）血管造影已应用于脑血管手术。颞浅动脉至大脑中动脉（STA-MCA）吻合术后，高灌注可能导致神经并发症。本研究的目的是使用显微镜集成动态ICG荧光分析定量评估术中脑灌注，并评估该值是否能预测STA-MCA吻合术后的高灌注综合征（HPS）。
纳入10例因单侧大脑主要动脉闭塞性疾病接受STA-MCA吻合术的患者。10例脑灌注正常的患者作为对照。记录来自皮质上六个感兴趣区域（ROI）的ICG通过曲线，这些区域对应于正电子发射断层扫描（PET）研究中的ROI。评估最大强度（IMAX）、脑血流指数（CBFi）、上升时间（RT）和达峰时间（TTP）。
RT/TTP能够区分对照组和研究对象，而IMAX或CBFi则不能。通过PET研究，RT/TTP与同侧与对侧半球的平均通过时间（MTT）/MTT比值相关（|r| = 0.534 - 0.807；P < 0.01）。Bland-Altman分析显示RT与MTT之间以及TTP与MTT之间的一致性界限较宽。术后发生HPS的患者旁路手术前后的RT比值显著低于未发生术后HPS的患者（分别为0.60 ± 0.032和0.80 ± 0.056；P = 0.017）。术后发生HPS的患者TTP比值也显著低于未发生术后HPS的患者（分别为0.64 ± 0.081和0.85 ± 0.095；P = 0.017）。
ICG通过曲线的时间依赖性术中参数提供了关于脑循环时间的定量信息，其质量和效用与PET获得的信息相当。这些参数可能有助于预测术后HPS的发生。
