Martirosyan Nikolay L, Skoch Jesse, Watson Jeffrey R, Lemole G Michael, Romanowski Marek, Anton Rein
*Division of Neurosurgery, University of Arizona, Tucson, Arizona; ‡Neurosurgery Research Laboratory, University of Arizona, Tucson, Arizona; §Department of Biomedical Engineering, University of Arizona, Tucson, Arizona.
Neurosurgery. 2015 Jun;11 Suppl 2(Suppl 2):252-7; discussion 257-8. doi: 10.1227/NEU.0000000000000681.
Preservation of adequate blood flow and exclusion of flow from lesions are key concepts of vascular neurosurgery. Indocyanine green (ICG) fluorescence videoangiography is now widely used for the intraoperative assessment of vessel patency.
Here, we present a proof-of-concept investigation of fluorescence angiography with augmented microscopy enhancement: real-time overlay of fluorescence videoangiography within the white light field of view of conventional operative microscopy.
The femoral artery was exposed in 7 anesthetized rats. The dissection microscope was augmented to integrate real-time electronically processed near-infrared filtered images with conventional white light images seen through the standard oculars. This was accomplished by using an integrated organic light-emitting diode display to yield superimposition of white light and processed near-infrared images. ICG solution was injected into the jugular vein, and fluorescent femoral artery flow was observed.
Fluorescence angiography with augmented microscopy enhancement was able to detect ICG fluorescence in a small artery of interest. Fluorescence appeared as a bright-green signal in the ocular overlaid with the anatomic image and limited to the anatomic borders of the femoral artery and its branches. Surrounding anatomic structures were clearly visualized. Observation of ICG within the vessel lumens permitted visualization of the blood flow. Recorded video loops could be reviewed in an offline mode for more detailed assessment of the vasculature.
The overlay of fluorescence videoangiography within the field of view of the white light operative microscope allows real-time assessment of the blood flow within vessels during simultaneous surgical manipulation. This technique could improve intraoperative decision making during complex neurovascular procedures.
维持充足的血流以及阻止病变部位的血流是血管神经外科的关键理念。吲哚菁绿（ICG）荧光血管造影术目前广泛用于术中评估血管通畅情况。
在此，我们展示了一项关于增强显微镜增强荧光血管造影术的概念验证研究：在传统手术显微镜的白光视野内实时叠加荧光血管造影图像。
在7只麻醉大鼠身上暴露股动脉。对解剖显微镜进行增强，以便将实时电子处理的近红外滤过图像与通过标准目镜看到的传统白光图像整合。这是通过使用集成有机发光二极管显示器来实现白光和处理后的近红外图像的叠加。将ICG溶液注入颈静脉，并观察股动脉的荧光血流。
增强显微镜增强荧光血管造影术能够在感兴趣的小动脉中检测到ICG荧光。荧光在叠加了解剖图像的目镜中呈现为亮绿色信号，且局限于股动脉及其分支的解剖边界内。周围的解剖结构清晰可见。观察血管腔内的ICG可使血流可视化。记录的视频环可在离线模式下查看，以便对脉管系统进行更详细的评估。
在白光手术显微镜视野内叠加荧光血管造影图像可在同时进行手术操作时实时评估血管内的血流。该技术可改善复杂神经血管手术中的术中决策。
