Takeshima Yasuhiro, Tanaka Yoshitaka, Hironaka Yasuo, Shida Yoichi, Nakase Hiroyuki
Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan,
Eur Spine J. 2015 May;24 Suppl 4:S585-9. doi: 10.1007/s00586-014-3755-3. Epub 2015 Jan 7.
To more safely resect pathological lesions during spinal vascular lesion surgery, it is most important to understand local abnormal hemodynamics in detail. New devices or techniques that make out intraoperative local hemodynamics have been awaited. To introduce a resourceful method, we present a case of spinal hemangioblastoma for which temporary arterial occlusion during near-infrared intraoperative indocyanine green (ICG) videoangiography gives useful assessment of the main and minor feeders easily.
A 36-year-old female suffered progressive paresthesia of both lower extremities for 12 months and gait disturbance for 2 weeks. A neurological examination revealed T10 myelopathy. Magnetic resonance imaging (MRI) of the thoracic spine showed an intramedullary tumor at the T8 level and severe spinal cord edema with a flow void in the extended dorsal spinal veins. Spinal angiography showed a hemangioblastoma at the T8 level, with two main feeders and minor feeders.
She underwent total resection of the tumor by a posterior approach. During the intraoperative ICG videoangiography, temporary arterial occlusion of the two main feeders and FLOW(®)800 analysis enabled clear understanding of the vasculature, especially of the two minor feeders. At the 9-month follow-up, her neurological manifestation was partially resolved, and post-operative MRI showed total removal of the tumor and disappearance of the spinal cord edema.
Temporary clipping of the main feeders during intraoperative ICG videoangiography is very useful for easily determining the minor feeding arteries, and helpful for maintaining normal perfusion of the spinal cord in spinal hemangioblastoma surgery. Furthermore, the FLOW 800 analysis, especially the false color-coded variation, increased our understanding of the hemodynamics.
为了在脊髓血管病变手术中更安全地切除病理性病变，详细了解局部异常血流动力学至关重要。人们一直期待有新的设备或技术能够明确术中局部血流动力学情况。为介绍一种巧妙的方法，我们报告一例脊髓血管母细胞瘤病例，在近红外术中吲哚菁绿（ICG）血管造影期间进行临时动脉闭塞，可轻松对主要和次要供血动脉进行有用的评估。
一名36岁女性双下肢进行性感觉异常12个月，步态障碍2周。神经系统检查显示T10脊髓病。胸椎磁共振成像（MRI）显示T8水平髓内肿瘤及严重脊髓水肿，扩张的脊髓背静脉有血流空洞。脊髓血管造影显示T8水平血管母细胞瘤，有两条主要供血动脉和次要供血动脉。
她通过后路进行了肿瘤全切术。在术中ICG血管造影期间，对两条主要供血动脉进行临时动脉闭塞及FLOW(®)800分析，能够清晰了解血管系统，尤其是两条次要供血动脉。在9个月的随访中，她的神经症状部分缓解，术后MRI显示肿瘤完全切除，脊髓水肿消失。
术中ICG血管造影期间对主要供血动脉进行临时夹闭，对于轻松确定次要供血动脉非常有用，有助于在脊髓血管母细胞瘤手术中维持脊髓的正常灌注。此外，FLOW 800分析，尤其是伪彩色编码变化，加深了我们对血流动力学的理解。
