Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
Department of Neurosurgery, University Hospital of Basel, Basel, Switzerland.
World Neurosurg. 2021 Jul;151:12-20. doi: 10.1016/j.wneu.2021.03.157. Epub 2021 Apr 8.
Several intraoperative imaging methods exist in cerebrovascular surgery to visualize and analyze the vascular anatomy flow. A new method based on multispectral fluorescence (MFL) imaging of indocyanine green (ICG) video angiography (VA) allows real-time, augmented reality (AR) visualization of blood flow superimposed on white-light microscopic images. We describe our single-center experience using MFL AR in cerebrovascular surgery.
Case descriptions are provided of cerebrovascular surgery with intraoperative use of MFL AR images performed at our institution from June 2018 to April 2020. MFL superimposes the blood flow in real time on white-light microscopic images. We used MFL AR imaging as well as standard ICG-VA visualization and intraoperative digital subtraction angiography (DSA) as a control.
A total of 39 cases (33 aneurysm clippings, 4 arteriovenous malformations, and 2 external carotid-internal carotid bypass surgeries), were performed using MFL technology-based AR visualization of ICG. MFL AR imaging and DSA showed a high correlation concerning aneurysm occlusion and vessel patency. In arteriovenous malformation resection surgery, MFL AR imaging facilitated early identification of the feeding arteries and draining veins. Because of increased sensitivity of MFL AR, a reduced dose of ICG could be used, allowing repeated intraoperative imaging. There were no postoperative complications, side effects, or technical problems related to the use of MFL AR imaging.
MFL AR is an easy-to-use adjunct in cerebrovascular surgery and shows a high correlation with intraoperative DSA. No interruption of the surgery is necessary because MFL AR images of the blood flow are superimposed in real time on white-light microscopic images.
在脑血管手术中存在几种术中成像方法，用于可视化和分析血管解剖结构和血流。一种新的基于吲哚菁绿（ICG）视频血管造影（VA）的多光谱荧光（MFL）成像的方法允许实时叠加白光显微镜图像上的血流，进行增强现实（AR）可视化。我们描述了我们在脑血管手术中使用 MFL AR 的单中心经验。
提供了在我们机构从 2018 年 6 月到 2020 年 4 月期间进行的使用术中 MFL AR 图像的脑血管手术的病例描述。MFL 实时将血流叠加在白光显微镜图像上。我们使用 MFL AR 成像以及标准的 ICG-VA 可视化和术中数字减影血管造影（DSA）作为对照。
总共进行了 39 例手术（33 例动脉瘤夹闭术，4 例动静脉畸形切除术和 2 例外颈动脉-颈内动脉旁路手术），使用基于 MFL 技术的 ICG 的 AR 可视化进行。MFL AR 成像和 DSA 在动脉瘤闭塞和血管通畅方面显示出高度相关性。在动静脉畸形切除术手术中，MFL AR 成像有助于早期识别供血动脉和引流静脉。由于 MFL AR 的灵敏度增加，可以减少 ICG 的剂量，从而允许重复进行术中成像。没有与使用 MFL AR 成像相关的术后并发症、副作用或技术问题。
MFL AR 是脑血管手术中一种易于使用的辅助手段，与术中 DSA 具有高度相关性。由于血流的 MFL AR 图像实时叠加在白光显微镜图像上，因此不需要中断手术。
