Fujita Health University Banbuntane Hotokukai Hospital, Nagoya, Japan.
Department of Traumatology, Orthopedics, Military-field surgery, and Neurosurgery of Tashkent Medical Academy, Republican Specialized Scientific-Practical Medical Center of Neurosurgery, Tashkent, Uzbekistan.
Br J Neurosurg. 2023 Dec;37(6):1652-1658. doi: 10.1080/02688697.2023.2207648. Epub 2023 May 3.
Visualization of cerebral vessels, their branches and the surrounding structures are essential during cerebrovascular surgery. Indocyanine green dye-based video angiography is a commonly used technique in cerebrovascular surgery. This paper aims to analyze the real-time imaging of ICG-AG, DIVA, and the use of ICG-VA with Flow 800 to compare their usefulness in surgery.
Intraoperative real-time identification of vascular and surrounding structures in twenty nine anterior circulation aneurysms and three posterior circulation aneurysm clipping, one STA-MCA bypass, and two carotid endarterectomies were performed in patients using ICG-VA alone, DIVA, ICG-VA with Flow 800 to analyze and compare each of these methods in details.
ICG-VA and DIVA couldn't visualize perforators in twenty-three cases of cerebral aneurysms clipping when used alone. Compared to that by adding Flow 800 perforators were easily visualized. In three cases, occlusion of perforators after clip application was visualized by DIVA and solved by repositioning surgical clips. In one STA-MCA bypass surgery, adequate blood flow to cortical branches of MCA (M4) from STA branches was assessed with ICG-VA, DIVA, and the use of ICG-VA with Flow 800 color mapping. ICG-VA, DIVA, and Flow 800 observed the lack of blood flow and fluttering atherosclerotic plaques in carotid endarterectomy. In one case of basilar tip aneurysm, we used ICG-VA with Flow 800; the intensity diagram drawn after determining regions of interest showed that there was no flow within the aneurysm sac after clipping.
In real-time surgery, a multimodal approach using ICG-VA, DIVA, and ICG-VA with Flow 800 colour mapping can serve as useful tools for better visualization of vascular and surrounding structures. The benefits of flow 800 color mapping, such as determining regions of interest, intensity diagrams, and color-coded images, outweigh the advantages over the ICG-VA and DIVA in the visualization of critical vascular anatomy in humans during surgical procedures.
在脑血管手术中，可视化脑血管、其分支和周围结构至关重要。基于吲哚菁绿染料的视频血管造影是脑血管手术中常用的技术。本文旨在分析 ICG-AG、DIVA 的实时成像，并比较使用 Flow 800 的 ICG-VA 在手术中的用途。
在 29 例前循环动脉瘤和 3 例后循环动脉瘤夹闭、1 例 STA-MCA 旁路和 2 例颈动脉内膜切除术的患者中，单独使用 ICG-VA、DIVA、ICG-VA 与 Flow 800 进行术中实时识别血管和周围结构，并对每种方法进行详细分析和比较。
单独使用 ICG-VA 和 DIVA 时，无法在 23 例脑动脉瘤夹闭中显示穿支血管。与单独使用相比，添加 Flow 800 后更容易显示穿支血管。在 3 例病例中，通过 DIVA 观察到夹闭后穿支血管闭塞，并通过重新定位手术夹解决。在 1 例 STA-MCA 旁路手术中，使用 ICG-VA、DIVA 和 ICG-VA 与 Flow 800 彩色映射评估 STA 分支向 MCA（M4）皮质分支的血流。ICG-VA、DIVA 和 Flow 800 观察到颈动脉内膜切除术中血流不畅和飘动的动脉粥样硬化斑块。在基底尖动脉瘤的 1 例病例中，我们使用了 ICG-VA 与 Flow 800；在确定感兴趣区域后绘制的强度图显示，夹闭后动脉瘤囊中没有血流。
在实时手术中，使用 ICG-VA、DIVA 和 ICG-VA 与 Flow 800 彩色映射的多模态方法可以作为更好地可视化血管和周围结构的有用工具。Flow 800 彩色映射的优势，如确定感兴趣区域、强度图和彩色图像，在手术过程中确定关键血管解剖结构的可视化方面优于 ICG-VA 和 DIVA。
