Department of Neurosurgery, PLA General Hospital, Beijing, 100853, China.
Sci Rep. 2017 Nov 1;7(1):14822. doi: 10.1038/s41598-017-05913-w.
This study aimed to explore the clinical applications of multimodal navigation combined with indocyanine green (ICG) fluorescein angiography in microsurgical treatment of cerebral arteriovenous malformations (AVMs). We retrospectively collected 52 patients with AVMs. Assisted by anatomic image, we reestablished three-dimensional structure using preoperative functional magnetic resonance imaging (fMRI) and Diffusion tensor imaging (DTI). The operation for lesion resection was finished under the assistance of neuro-navigation. ICG fluorescein angiography was performed for 16 of the study subjects, meanwhile, FLOW800 was used to rebuild blood vessel color visual image. Brain angiography was performed 1 week after the operation to check residual malformations. The patients' status was estimated by Modified Rankin Scale score. Of the AVMs, 92.3% (48/52) were totally removed, without severe side events. Among the patients, fluorescein angiography was carried out up to 58 times for 16 cases. All of these 16 cases were confirmed with malformations and 14 of them had draining vein. The total resection rate of these 16 cases reached 100%, and the occurrence rate of postoperative complications was not significantly increased. During the operation of lesion resection, the application of multimodal navigation could effectively protect functional cortex and conduction pathway.
本研究旨在探讨多模态导航联合吲哚菁绿（ICG）荧光血管造影在脑动静脉畸形（AVM）显微手术治疗中的临床应用。我们回顾性收集了 52 例 AVM 患者的资料。在解剖图像的辅助下，我们使用术前功能磁共振成像（fMRI）和弥散张量成像（DTI）重建三维结构。在神经导航的辅助下完成病变切除手术。对其中 16 例患者进行了 ICG 荧光血管造影，同时使用 FLOW800 重建血管彩色可视化图像。术后 1 周进行脑血管造影检查以检查残余畸形。采用改良 Rankin 量表评分评估患者的状态。52 例 AVM 中，92.3%（48/52）完全切除，无严重不良反应。其中，16 例患者共进行了 58 次荧光血管造影检查，所有患者均确诊存在畸形，其中 14 例有引流静脉。这 16 例患者的完全切除率达到 100%，且术后并发症发生率并未显著增加。在病变切除手术过程中，多模态导航的应用可以有效地保护功能皮层和传导束。
