Toi Hiroyuki, Matsushita Nobuhisa, Ogawa Yukari, Kinoshita Keita, Satoh Kohei, Takai Hiroki, Hirai Satoshi, Hara Keijiro, Matsubara Shunji, Uno Masaaki
Department of Neurosurgery, Kawasaki Medical School.
Neurol Med Chir (Tokyo). 2018 Feb 15;58(2):85-90. doi: 10.2176/nmc.tn.2017-0160. Epub 2017 Dec 1.
Indocyanine green (ICG) emits fluorescence in the far-red domain under light excitation. ICG video angiography (ICG-VA) has been established as a useful method to evaluate blood flow in the operative field. We report the usefulness of ICG-VA for Sylvian fissure dissection in patients with subarachnoid hemorrhage (SAH). Subjects comprised 7 patients who underwent ICG-VA before opening the Sylvian fissure during neck clipping for ruptured cerebral aneurysm. We observed contrasted Sylvian veins before opening the Sylvian fissure using surgical microscopes. This procedure was termed "Sylvian ICG". We observed ICG fluorescence quickly in all cases. Sylvian veins that appeared unclear in the standard microscopic operative field covered with subarachnoid hemorrhage were extremely clearly depicted. These Sylvian ICG findings were helpful in identifying entry points and the dissecting course of the Sylvian fissure. At the time of clipping, no residual fluorescence from Sylvian ICG was present, and aneurysm clipping was not impeded. Sylvian ICG for SAH patients is a novel technique to facilitate dissection of the Sylvian fissure. We believe that this technique will contribute to improved safety of clipping surgery for ruptured aneurysms.
吲哚菁绿（ICG）在光激发下于远红区域发出荧光。吲哚菁绿视频血管造影术（ICG-VA）已成为评估手术区域血流的一种有用方法。我们报告了ICG-VA在蛛网膜下腔出血（SAH）患者大脑外侧裂分离术中的应用价值。研究对象包括7例在破裂脑动脉瘤颈部夹闭手术中打开大脑外侧裂之前接受ICG-VA检查的患者。我们使用手术显微镜在打开大脑外侧裂之前观察对比大脑外侧静脉。此操作被称为“大脑外侧裂ICG”。我们在所有病例中均快速观察到ICG荧光。在被蛛网膜下腔出血覆盖的标准显微镜手术视野中显得不清晰的大脑外侧静脉被极其清晰地描绘出来。这些大脑外侧裂ICG的发现有助于确定大脑外侧裂的进入点和分离路径。在夹闭时，大脑外侧裂ICG没有残留荧光，且动脉瘤夹闭未受阻碍。对于SAH患者，大脑外侧裂ICG是一种有助于大脑外侧裂分离的新技术。我们相信该技术将有助于提高破裂动脉瘤夹闭手术的安全性。
