Rennert Robert C, Strickland Ben A, Ravina Kristine, Bakhsheshian Joshua, Russin Jonathan J
Department of Neurological Surgery, University of California San Diego, San Diego, California, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
World Neurosurg. 2018 Jun;114:352-360. doi: 10.1016/j.wneu.2018.03.189. Epub 2018 Apr 4.
Intraoperative blood flow assessments during cerebral bypass would ideally assess vessel patency, downstream perfusion, and risk of postoperative hyperperfusion syndrome (HPS). Previous studies using indocyanine green-based flow analyses (ICG-BFA) have identified multiple parameters that can intraoperatively track bypass-related changes in cerebral perfusion and potentially predict postoperative risk of HPS. Herein, we determine the most robust parameter and anatomic location for intraoperative ICG-BFA assessment of bypass-related perfusion changes and prediction of postoperative risk of HPS.
Retrospective analysis of an institutional review board-approved prospective database identified patients undergoing superficial temporal artery-to-middle cerebral artery bypass. Demographic and clinical information, as well as manually calculated and automated pre- and postbypass intraoperative ICG-BFA data from cortical, arterial, and venous regions of interest were recorded and analyzed.
Seven patients underwent superficial temporal artery-to-middle cerebral artery bypass (4 Moyamoya, 3 carotid occlusions). Average age was 48.2 ± 13.9 years (3 female, 4 male). Although all parameters measured showed trends toward improvement postbypass, only changes in arterial and venous automated ICG-BFA slope (also known as blood flow index [maximum intensity/rise time]) reached significance. None of the patients experienced symptomatic HPS, despite 5 of 7 (71.4%) having an increased HPS risk based on previously published ICG-BFA data.
ICG-BFA has utility for the intraoperative assessment of bypass-related changes in cerebral perfusion, with automated blood flow index being the most robustly affected parameter. Although previously published ICG-BFA indices did not predict the development of symptomatic postoperative HPS, larger-scale studies correlating observed ICG-BFA changes with risk of HPS are warranted.
在脑搭桥手术期间进行术中血流评估，理想情况下应评估血管通畅性、下游灌注以及术后高灌注综合征（HPS）的风险。先前使用基于吲哚菁绿的血流分析（ICG-BFA）的研究已经确定了多个参数，这些参数可以在术中追踪与搭桥相关的脑灌注变化，并有可能预测术后HPS的风险。在此，我们确定用于术中ICG-BFA评估搭桥相关灌注变化和预测术后HPS风险的最可靠参数和解剖位置。
对一个经机构审查委员会批准的前瞻性数据库进行回顾性分析，确定接受颞浅动脉至大脑中动脉搭桥手术的患者。记录并分析人口统计学和临床信息，以及来自感兴趣的皮质、动脉和静脉区域的术前和术后手动计算及自动的术中ICG-BFA数据。
7例患者接受了颞浅动脉至大脑中动脉搭桥手术（4例烟雾病，3例颈动脉闭塞）。平均年龄为48.2±13.9岁（3例女性，4例男性）。尽管测量的所有参数在搭桥后均显示出改善趋势，但只有动脉和静脉自动ICG-BFA斜率的变化（也称为血流指数[最大强度/上升时间]）达到显著水平。尽管根据先前发表的ICG-BFA数据，7例患者中有5例（71.4%）HPS风险增加，但没有患者出现有症状的HPS。
ICG-BFA可用于术中评估与搭桥相关的脑灌注变化，自动血流指数是受影响最显著的参数。尽管先前发表的ICG-BFA指数未能预测术后有症状HPS的发生，但仍需要进行更大规模的研究，将观察到的ICG-BFA变化与HPS风险相关联。
