Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
Department of Neurosurgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
World Neurosurg. 2021 Jul;151:132-137. doi: 10.1016/j.wneu.2021.05.019. Epub 2021 May 15.
It is crucial to identify a shunt point for spinal arteriovenous malformation (AVM) treatment. For this purpose, some intraoperative supports have been reported-intravenous injection of indocyanine green (ICG), selective arterial injection of ICG, and selective arterial injection of saline with a high frame rate digital camera. However, there are difficulties in accurately identifying the shunt point, especially if the lesion has multiple feeders. The aim of this technical note was to report a novel method, selective arterial injection of saline to subtract signals of ICG, to precisely identify perimedullary arteriovenous fistula shunt points having multiple feeding arteries.
After exposing the lesion, a 4-F catheter was cannulated into the origins of the segmental artery. ICG was injected intravenously as a first step, and then heparinized saline solution was flushed from the catheter.
Compared with other methods, this method could identify the exact shunt point and was effective for certain shunt point obliterations.
Despite having similar invasiveness, selective arterial injection of saline to subtract signals of ICG is superior to previously described techniques, such as selective arterial injection of ICG. Therefore, it will be useful in spinal arteriovenous malformation surgical treatment.
确定脊髓动静脉畸形（AVM）治疗的分流点至关重要。为此，已经报道了一些术中支持方法，包括静脉注射吲哚菁绿（ICG）、选择性动脉注射 ICG 和使用高帧率数字相机选择性动脉注射盐水。然而，准确识别分流点存在困难，特别是在病变有多个供血动脉的情况下。本技术说明的目的是报告一种新方法，即选择性动脉注射盐水以减去 ICG 的信号，以精确识别具有多个供血动脉的脊髓动静脉瘘分流点。
暴露病变后，将 4-F 导管插入节段动脉的起源处。首先静脉内注射 ICG，然后从导管中冲洗肝素化盐水。
与其他方法相比，该方法可以确定准确的分流点，并且对某些分流点闭塞有效。
尽管具有相似的侵袭性，但选择性动脉注射盐水以减去 ICG 的信号优于先前描述的技术，如选择性动脉注射 ICG。因此，它将在脊髓动静脉畸形的手术治疗中有用。
