Koizumi Hiroyuki, Hide Takuichiro, Yamamoto Daisuke, Hyakutake Yuri, Handa Hajime, Komai Hideto, Asari Yasushi, Kumabe Toshihiro
Departments of1Neurosurgery and.
2Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
J Neurosurg Case Lessons. 2022 Aug 1;4(5). doi: 10.3171/CASE22237.
Hemorrhagic moyamoya disease (MMD) and the fragile periventricular collaterals are known to have a causal relationship. Digital subtraction angiography and magnetic resonance angiography have shown the presence of fragile periventricular moyamoya vessels. However, dynamic fragile periventricular moyamoya vessels have never been observed under direct vision.
The authors treated two patients with hemorrhagic MMD: a 42-year-old man with intraventricular hemorrhage and a 47-year-old woman with intracerebral hemorrhage. Endoscope-integrated indocyanine green video angiography (EICG angiography) could visualize the dynamic fragile periventricular collaterals. In particular, EICG angiography enabled visualization of invisible moyamoya vessels buried in the subependyma and characterization of the blood flow in the moyamoya vessels located inside the lateral ventricles and hematoma cavity.
EICG angiography can confirm the fragile periventricular collaterals associated with MMD by direct visualization. The high spatial resolution and real-time imaging can help to avoid accidental hemorrhage in and after evacuation of hemorrhage in patients with MMD.
出血性烟雾病（MMD）与脆弱的脑室周围侧支血管之间存在因果关系。数字减影血管造影和磁共振血管造影已显示存在脆弱的脑室周围烟雾状血管。然而，从未在直视下观察到动态的脆弱脑室周围烟雾状血管。
作者治疗了两名出血性MMD患者：一名42岁的男性，患有脑室内出血；一名47岁的女性，患有脑出血。内镜集成吲哚菁绿视频血管造影（EICG血管造影）能够可视化动态脆弱的脑室周围侧支血管。特别是，EICG血管造影能够可视化埋藏在室管膜下的不可见烟雾状血管，并对位于侧脑室和血肿腔内的烟雾状血管中的血流进行特征描述。
EICG血管造影可以通过直接可视化来确认与MMD相关的脆弱脑室周围侧支血管。高空间分辨率和实时成像有助于避免MMD患者在出血清除过程中和清除后意外出血。
