Department of Neurological Surgery, University of California San Diego, San Diego, CA, USA.
Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
J Clin Neurosci. 2019 Sep;67:191-197. doi: 10.1016/j.jocn.2019.06.036. Epub 2019 Jun 29.
Cerebral bypass is often needed for complex aneurysms requiring vessel sacrifice, yet intraoperative predictors of ischemic risk in bypass-dependent territories are limited. Indocyanine Green (ICG)-based flow analyses (ICG-BFAs; Flow 800, Carl Zeiss, Oberkochen, Germany) semi-quantitatively assess cortical perfusion, and in this work we determine the efficacy of ICG-BFA for assessing post-operative ischemic risk during cerebral bypass surgery for complex aneurysms. Retrospective clinical and pre/post-bypass intra-operative ICG-BFA data (delay and blood flow index [BFI]) on ten patients undergoing cerebral bypass for complex cerebral aneurysms requiring vessel sacrifice were collected from a single-institution prospective database and analyzed via non-parametric testing and logistic regression. Mean age was 55.9 ± 14.8 years. Pre/post-bypass delay (median 35.6 [5.1-51.3] vs. 26.0 [17.1-59.9]; p = 0.2) and BFI (median 56.1 [8.1-120.4] vs. 32.2 [3.0-147.4]; p = 0.2) did not significantly differ. Two patients (20%) developed post-operative ischemia in bypass dependent territories. Delay ratio did not differ between patients with and without post-operative ischemia (median 1.15 [0.67-1.64] vs. 0.83 [0.36-3.56]; p = 0.6), nor predict stroke risk (odds ratio = 1.1, p = 0.9). Conversely, BFI ratio was significantly lower for patients experiencing post-operative ischemia than those without ischemia (median 0.11 [0.06-0.17] vs. 0.99 [0.28-1.42]; p = 0.03). A BFI ratio <0.21 predicted the occurrence of post-operative ischemia (odds ratio = 0.02, p = 0.05). These data suggest that intraoperative ICG-BFA may help assess post-operative ischemic risk during cerebral bypass surgery for complex aneurysms requiring vessel sacrifice.
脑旁路手术常用于需要血管牺牲的复杂动脉瘤，但旁路依赖区域的术中缺血风险预测指标有限。吲哚菁绿（ICG）基础的血流分析（ICG-BFA；Flow 800，德国卡尔蔡司）半定量评估皮质灌注，在此工作中，我们确定 ICG-BFA 用于评估复杂动脉瘤血管牺牲的脑旁路手术中术后缺血风险的有效性。从一家机构前瞻性数据库中收集了 10 名因复杂脑动脉瘤而需要血管牺牲而行脑旁路手术的患者的临床回顾性和旁路前后术中 ICG-BFA 数据（延迟和血流指数[BFI]），并通过非参数检验和逻辑回归进行分析。平均年龄为 55.9±14.8 岁。旁路前后的延迟（中位数 35.6[5.1-51.3]与 26.0[17.1-59.9]；p=0.2）和 BFI（中位数 56.1[8.1-120.4]与 32.2[3.0-147.4]；p=0.2）差异无统计学意义。2 名患者（20%）在旁路依赖区域发生术后缺血。术后缺血患者与无术后缺血患者的延迟比无显著差异（中位数 1.15[0.67-1.64]与 0.83[0.36-3.56]；p=0.6），也不能预测卒中风险（比值比 1.1，p=0.9）。相反，发生术后缺血的患者 BFI 比值明显低于无缺血的患者（中位数 0.11[0.06-0.17]与 0.99[0.28-1.42]；p=0.03）。BFI 比值<0.21 预测术后缺血的发生（比值比 0.02，p=0.05）。这些数据表明，术中 ICG-BFA 可能有助于评估需要血管牺牲的复杂动脉瘤脑旁路手术中的术后缺血风险。
