Shaikh Noah, O'Brien Daniel, Makary Chadi, Turner Meghan
Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, United States.
Division of Otolaryngology, University of Alberta, Edmonton, Alberta, Canada.
J Neurol Surg B Skull Base. 2021 Jul 19;83(Suppl 2):e492-e500. doi: 10.1055/s-0041-1732309. eCollection 2022 Jun.
This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap. The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications. Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI ( = 0.008) and CSF leak ( = 0.315) by Fisher's exact test. The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis. This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.
本研究旨在探讨术中吲哚菁绿（ICG）血管造影在颅底重建中的应用现状，并了解其在预测术后磁共振成像（MRI）强化及皮瓣情况方面的疗效。
从数据库建立至2020年8月，检索了Embase、Cochrane对照试验中心注册库（CENTRAL）、科学网和谷歌学术数据库，以查找有关颅底重建术中ICG皮瓣灌注评估的研究。主要关注的结局是颅底重建后脑脊液（CSF）漏的发生情况。次要关注的结局包括术后脑膜炎、皮瓣MRI强化、皮瓣坏死、皮瓣灌注测量以及总并发症。
检索结果得到189项研究，最终分析纳入了7项研究，共104例患者。其中有44例鼻中隔皮瓣（NSF）、2例鼻侧壁皮瓣（LNWF）、14例颅骨膜皮瓣（PCF）和44例微血管游离皮瓣。CSF漏和术后MRI强化的发生率分别为11%和94%。有1例术后脑膜炎病例。通过Fisher精确检验对现有数据进行的汇总分析表明，术中ICG皮瓣灌注与术后MRI上的皮瓣强化（P = 0.008）及CSF漏（P = 0.315）相关。
现有文献表明术中ICG强化与术后MRI强化相关。鉴于文献中的样本量较小以及颅底重建相关并发症的罕见性，术中ICG强化尚未能预测皮瓣坏死或术后并发症，如CSF漏或脑膜炎。
本研究作为对病例研究、病例报告以及无盲法、对照且参考标准应用不一致的回顾性和前瞻性试验的系统评价，提供了3级证据。
