Kanemaru Kazuya, Yoshioka Hideyuki, Hashimoto Koji, Murayama Hiroaki, Ogiwara Masakazu, Yagi Takashi, Horikoshi Tohru, Kinouchi Hiroyuki
Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan.
World Neurosurg. 2019 Jun;126:e573-e579. doi: 10.1016/j.wneu.2019.02.097. Epub 2019 Mar 1.
Confirming the exact location of a fistula and the origins of draining veins during surgery for dural and perimedullary arteriovenous fistulas (AVFs) is crucial but sometimes inadequately performed, which can result in incomplete elimination of the lesion. Intraoperative digital subtraction angiography (DSA) is the gold standard for confirming the hemodynamics of an AVF; however, it cannot reveal the location of an AVF in the operative field. In this study, the efficacy of intraoperative intraarterial fluorescence video angiography during surgery for craniocervical junction dural and perimedullary AVFs was investigated.
We repeatedly employed this technology to evaluate its usefulness in revealing the flow dynamics and anatomy of AVFs and to confirm complete elimination of the fistula.
Seven AVFs were included in this study. Their locations were C1 in 5 cases and C2 in 2 cases. Intraarterial fluorescence video angiography precisely revealed the locations of 3 dural AVFs, 1 perimedullary AVF, and 3 co-occurring dural and perimedullary AVFs. Frame-by-frame review of the fluorescence video angiography clearly demonstrated that fluorescence appeared earlier in the perimedullary AVF than in the draining vein through the dural AVF after intraarterial injection in all 3 co-occurring cases. Complete elimination of the AVF was also confirmed in all cases by fluorescence video angiography, as well as intraoperative and follow-up DSA.
Intraarterial fluorescence video angiography, particularly frame-by-frame review, enables surgeons to distinguish the flow dynamics of AVFs and contributes to the planning of effective surgical strategies for optimal results.
在硬脑膜和髓周动静脉瘘（AVF）手术中，确定瘘管的确切位置以及引流静脉的起源至关重要，但有时操作并不充分，这可能导致病变无法完全消除。术中数字减影血管造影（DSA）是确认AVF血流动力学的金标准；然而，它无法显示手术视野中AVF的位置。在本研究中，我们调查了术中动脉内荧光视频血管造影在颅颈交界区硬脑膜和髓周AVF手术中的疗效。
我们反复应用该技术来评估其在揭示AVF血流动力学和解剖结构以及确认瘘管完全消除方面的有用性。
本研究纳入了7例AVF。其位置为5例在C1，2例在C2。动脉内荧光视频血管造影精确显示了3例硬脑膜AVF、1例髓周AVF以及3例同时存在的硬脑膜和髓周AVF的位置。在所有3例同时存在的病例中，对荧光视频血管造影进行逐帧回顾清楚地表明，动脉内注射后，髓周AVF中的荧光比通过硬脑膜AVF的引流静脉中的荧光出现得更早。荧光视频血管造影以及术中DSA和随访DSA均证实所有病例中的AVF已完全消除。
动脉内荧光视频血管造影，尤其是逐帧回顾，使外科医生能够区分AVF的血流动力学，并有助于制定有效的手术策略以获得最佳结果。
