Chen D Y, Xu C S, Fu K, Ma Y H, Zhang T B, Zou Y C, Chen J C
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China.
Zhonghua Yi Xue Za Zhi. 2021 Jan 26;101(4):254-258. doi: 10.3760/cma.j.cn112137-20200425-01317.
To explore the value of neuroendoscopy combined with fluorescence angiography in anterior circulation aneurysm clipping. A total of 15 patients with anterior circulation aneurysm from Department of Neurosurgery, Zhongnan Hospital of Wuhan University between October 2018 and January 2019 were enrolled. Neuroendoscopy combined with indocyanine green fluorescence angiography (ICGA) was used to determine the shape of the aneurysm, the specific location of the aneurysm neck and its relationship with the aneurysm-bearing artery during anterior circulation aneurysm clipping. Meanwhile, Neuroendoscopy combined with ICGA can be employed to observe whether there was stenosis and incomplete clamping of the aneurysm-bearing artery after clipping the aneurysm, and whether there was misclamping of the perforating branches hidden under the posterior wall of the aneurysm. The success rate of aneurysm clipping in 15 cases was 15/15. After aneurysm clipping, ICGA and neuroendoscopy were performed. The residual aneurysm neck was detected in 3 cases, and the position of aneurysm clip was adjusted or aneurysm clips were added. In one case, the anterior choroidal aneurysm was found to be mistakenly clipped. After adjusting the aneurysm clip, ICGA and neuroendoscopy showed that the anterior choroidal artery was normal. In another case, the A1 segment aneurysm was clipped. ICGA and neuroendoscopy found that the perforating branch blood vessels were mistakenly clipped. After the adjustment of the aneurysm clip, the blood vessels recovered their patency. There were no surgical-related deaths, disability and coma cases in the study. During aneurysm clipping, neuroendoscopy combined with ICGA can reduce cerebral vasospasm, decrease the misclipping rate of perforation of blood vessels, and avoid residual neck of aneurysm, stenosis or occlusion of aneurysm-bearing artery by using neuroendoscopy to observe whether misclipping of the perforating branch vessels exist and whether the aneurysm is clipped. Therefore, it can reduce postoperative complications.
探讨神经内镜联合荧光血管造影在大脑前循环动脉瘤夹闭术中的应用价值。选取2018年10月至2019年1月武汉大学中南医院神经外科收治的15例大脑前循环动脉瘤患者。在大脑前循环动脉瘤夹闭术中，采用神经内镜联合吲哚菁绿荧光血管造影（ICGA）确定动脉瘤形态、瘤颈具体位置及其与载瘤动脉的关系。同时，神经内镜联合ICGA可用于观察动脉瘤夹闭后载瘤动脉有无狭窄及夹闭不全，以及动脉瘤后壁下方隐藏的穿支有无误夹。15例动脉瘤夹闭成功率为15/15。动脉瘤夹闭术后行ICGA及神经内镜检查。3例检测到残余瘤颈，调整动脉瘤夹位置或增加动脉瘤夹。1例脉络膜前动脉瘤被误夹，调整动脉瘤夹后，ICGA及神经内镜显示脉络膜前动脉正常。另1例A1段动脉瘤夹闭后，ICGA及神经内镜发现穿支血管被误夹，调整动脉瘤夹后血管恢复通畅。本研究无手术相关死亡、致残及昏迷病例。在动脉瘤夹闭术中，神经内镜联合ICGA可减轻脑血管痉挛，降低血管穿支误夹率，通过神经内镜观察穿支血管有无误夹及动脉瘤夹闭情况，避免动脉瘤残余瘤颈、载瘤动脉狭窄或闭塞，从而减少术后并发症。
