Yokota Hiroshi, Yonezawa Taiji, Yamada Tomonori, Miyamae Seisuke, Kim Taekyun, Takamura Yoshiaki, Masui Katsuya, Aketa Shuta
Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan; Department of Neurosurgery, Nara Medical University, Kashihara, Nara, Japan.
Department of Neurosurgery, Osaka Police Hospital, Osaka, Japan.
World Neurosurg. 2017 Oct;106:446-449. doi: 10.1016/j.wneu.2017.07.004. Epub 2017 Jul 12.
Neurosurgical application of indocyanine green (ICG) videography before performing a dural opening, known as transdural ICG videography, has been used during surgery of meningiomas associated with venous sinuses as well as cranial and spinal arteriovenous malformations. However, its use for a superficial temporal artery (STA)-to-middle cerebral artery (MCA) bypass has not been reported.
We performed a retrospective analysis of medical records of patients who underwent transdural ICG videography during STA-MCA bypass performed between January 2012 and March 2015. The primary outcome was visualization of recipient cortical arteries; secondary outcomes were surgical modifications and complications as well as any adverse events associated with transdural ICG videography.
We analyzed 29 STA-MCA bypass procedures performed in 30 hemispheres with atherosclerotic steno-occlusive disease and found that the proper recipient was identified in 28 hemispheres. Subsequently modified procedures for those were a tailored dural incision and craniotomy correction. No complications associated with ICG administration were encountered; during the postoperative course, transient aphasia was noted in 1 case, chronic subdural hematoma was noted in 1 case, and subdural effusion was noted in 2 cases.
Transdural ICG videography for atherosclerotic steno-occlusive disease facilitates modifications during STA-MCA bypass procedures. Recognition of the proper recipient cortical arteries before a dural incision allows the neurosurgeon to perform a tailored dural incision and extension of the bone window, although the contribution to surgical outcome has yet to be determined.
在硬脑膜切开前应用吲哚菁绿（ICG）血管造影术，即经硬脑膜ICG血管造影术，已用于静脉窦相关脑膜瘤以及颅和脊髓动静脉畸形的手术中。然而，其在颞浅动脉（STA）-大脑中动脉（MCA）搭桥术中的应用尚未见报道。
我们对2012年1月至2015年3月期间行STA-MCA搭桥术时接受经硬脑膜ICG血管造影术的患者的病历进行了回顾性分析。主要结局是受体皮质动脉的可视化；次要结局是手术调整、并发症以及与经硬脑膜ICG血管造影术相关的任何不良事件。
我们分析了在30个半球中对患有动脉粥样硬化性狭窄闭塞性疾病进行的29例STA-MCA搭桥手术，发现28个半球中确定了合适的受体。随后对这些患者进行的手术调整是定制硬脑膜切口和颅骨切开术矫正。未遇到与ICG给药相关的并发症；在术后过程中，1例出现短暂性失语，1例出现慢性硬膜下血肿，2例出现硬膜下积液。
经硬脑膜ICG血管造影术用于动脉粥样硬化性狭窄闭塞性疾病有助于STA-MCA搭桥手术中的调整。在硬脑膜切开前识别合适的受体皮质动脉可使神经外科医生进行定制的硬脑膜切口和扩大骨窗，尽管其对手术结局的贡献尚待确定。
