Department of Neurological Surgery, University of California San Diego, San Diego, California.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California.
Oper Neurosurg (Hagerstown). 2019 May 1;16(5):583-592. doi: 10.1093/ons/opy154.
Revascularization strategies for complex cerebral aneurysms are largely based on subjective interpretation of flow demands, or indirect measures of perfusion in at-risk territories. Indocyanine Green -based flow analyses ((ICG-BFA); Flow 800, Carl Zeiss, Oberkochen, Germany) provide a real-time, semiquantitative measure of intraoperative cortical perfusion during cerebral bypass surgery for complex aneurysms.
To determine the utility of intraoperative ICG-BFA for assessing cortical perfusion in at-risk territories during cerebral bypass for complex aneurysms requiring vessel sacrifice.
Retrospective analysis of consecutive patients from a prospective, single-institution open cerebrovascular database.
Intraoperative ICG-BFA confirmed adequate cortical perfusion in 2 patients with fusiform posterior circulation aneurysms, treated with a posterior inferior cerebellar artery (PICA)-PICA and occipital artery (OA)-to-third segment of the posterior cerebral artery (P3) bypass with proximal vessel sacrifice, respectively. ICG-BFA was used in a third patient that underwent clip reconstruction/ intracranial-to-intracranial bypass for a large middle cerebral artery (MCA) bifurcation aneurysm requiring sacrifice of the temporal M2 branch. In this case, a frontal M3 to temporal M3 side-to-side anastomosis was created to arborize the MCA tree and allow filling of both M2 territories through a single M2 branch. After aneurysm reconstruction, ICG-BFA identified an inadvertent occlusion of the frontal M2 that left the entire MCA distribution reliant on collateral flow but did not cause a neuromonitoring change. Repeat ICG-BFA after clip re-arrangement demonstrated aneurysm occlusion and equal flow in both frontal and temporal MCA cortical distributions from the arborization.
ICG-BFA is a useful adjunct for intraoperative cortical flow assessment during cerebral revascularization for complex aneurysms requiring vessel sacrifice.
复杂脑动脉瘤的血运重建策略主要基于对血流需求的主观解释，或对风险区域灌注的间接测量。吲哚菁绿（ICG）-基础血流分析（ICG-BFA）（Flow 800，德国卡尔蔡司，Oberkochen）为复杂动脉瘤脑旁路手术期间提供了一种实时、半定量的皮质灌注测量方法。
确定术中 ICG-BFA 在需要血管牺牲的复杂动脉瘤脑旁路手术中评估风险区域皮质灌注的效用。
对前瞻性、单机构开放脑血管数据库中连续患者进行回顾性分析。
术中 ICG-BFA 证实了 2 例后循环梭形动脉瘤患者的皮质灌注充足，分别接受了后下小脑动脉（PICA）-PICA 和枕动脉（OA）-第三段大脑后动脉（P3）旁路手术，近端血管牺牲。第三例患者接受了夹闭重建/颅内外旁路手术，用于治疗需要牺牲颞支 M2 分支的大型大脑中动脉（MCA）分叉动脉瘤。在这种情况下，创建了额支 M3 至颞支 M3 的侧侧吻合术，以使 MCA 树分叉，并通过单个 M2 分支使两个 M2 区域充盈。在动脉瘤重建后，ICG-BFA 发现了意外的额支 M2 闭塞，使整个 MCA 分布依赖于侧支循环，但没有导致神经监测变化。夹重新排列后的 ICG-BFA 显示动脉瘤闭塞，从分叉处，额支和颞支 MCA 皮质分布的血流相等。
ICG-BFA 是一种有用的辅助手段，可用于需要血管牺牲的复杂动脉瘤脑血运重建术中的皮质血流评估。
