Shah Abhidha, Rangarajan Vithal, Kaswa Amol, Jain Sonal, Goel Atul
Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2016 Jul-Sep;11(3):276-81. doi: 10.4103/1793-5482.175626.
Many controversies exist regarding the extent of resection for insular gliomas and the timing of resection. Several techniques and adjuncts are used to maximize safety during resection of these tumors. We describe the use of indocyanine green (ICG) to identify the branches of the middle cerebral artery and discuss its utility to increase safety for resection for insular gliomas.
Five patients with insular gliomas were surgically treated by the authors from June 2013 to June 2014. The patients presented with complaints of either a headache or recurring episodes of convulsions. All the patients were operated with the aid of neuronavigation and tractography. The long perforating branches of the middle cerebral artery course through the insula and pass onward to supply the corona radiata. It is essential to preserve these vessels to prevent postoperative neurological deficits. ICG (Aurogreen) was used to identify and preserve the long perforating arteries of the middle cerebral artery.
ICG dye correctly identified the long perforating branches of the middle cerebral artery and easily distinguished these vessels from the short perforating branches. All the branches of the middle cerebral artery that coursed through the tumor and had an onward course were preserved in all the patients. Only one patient developed a transient right sided hemiparesis that had improved at follow-up.
Surgery for insular gliomas is challenging due to its location adjacent to eloquent areas, important white fiber tracts and the course of the middle cerebral artery within it. ICG is useful to identify and preserve the long perforating branches of the middle cerebral artery that course through the tumor and traverse onward to supply the corona radiata.
关于岛叶胶质瘤的切除范围和切除时机存在诸多争议。在这些肿瘤切除过程中，人们使用了多种技术和辅助手段以最大限度地提高安全性。我们描述了使用吲哚菁绿（ICG）来识别大脑中动脉分支，并讨论其在提高岛叶胶质瘤切除安全性方面的效用。
2013年6月至2014年6月，作者对5例岛叶胶质瘤患者进行了手术治疗。患者均有头痛或反复发作惊厥的主诉。所有患者均在神经导航和神经纤维束成像辅助下进行手术。大脑中动脉的长穿支穿过岛叶并继续前行供应放射冠。保留这些血管对于预防术后神经功能缺损至关重要。使用吲哚菁绿（奥绿）来识别和保留大脑中动脉的长穿支动脉。
吲哚菁绿染料正确识别了大脑中动脉的长穿支，并能轻松将这些血管与短穿支区分开来。所有患者中，所有穿过肿瘤并继续前行的大脑中动脉分支均得以保留。只有1例患者出现短暂性右侧偏瘫，随访时有所改善。
由于岛叶胶质瘤位于功能区附近、重要白质纤维束以及大脑中动脉走行区域内，其手术具有挑战性。吲哚菁绿有助于识别和保留穿过肿瘤并继续前行供应放射冠的大脑中动脉长穿支。
