Microscope-Integrated Quantitative Analysis of Intraoperative Indocyanine Green Fluorescence Angiography for Blood Flow Assessment: First Experience in 30 Patients
Microscope-Integrated Quantitative Analysis of Intraoperative Indocyanine Green Fluorescence Angiography for Blood Flow Assessment: First Experience in 30 Patients
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DOI：
10.1227/neu.0b013e31822f7d7c
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发表时间：
2012-03-01
期刊：
影响因子：
4.8
通讯作者：
Stummer, Walter
中科院分区：
文献类型：
--
作者：
Kamp, Marcel A.;Slotty, Philipp;Stummer, Walter
背景：在血管神经外科手术中，术中测量脑血流量很有意义。近红外吲哚菁绿色（ICG）荧光血管造影术被引入用于术中血管通畅性的可视化。然而，定量的信息还没有提供。目的：报告我们的经验与显微镜与集成的动态ICG荧光分析系统提供半定量信息的血流。方法：我们记录了ICG荧光曲线的皮质和脑血管使用软件集成到手术显微镜（流800软件;蔡司Pentero）在30例患者接受手术的不同病理。结果：在无明显灌注缺损的患者中，最大荧光强度为177.7任意强度单位（Arbitrary IntensityUnits），最大荧光强度为177.7任意强度单位（Arbitrary IntensityUnits（AI; 5 mg ICG推注），平均上升时间为5.2秒（范围，2.9-8.2秒; SD，1.3秒），平均达峰时间为9.4秒（范围，4.9-15.2秒; SD，2.5秒），平均脑血流指数为38.6 AI/s（范围，13.5-180.6 AI/s; SD，36.9秒），平均通过时间为1.5秒（范围，360毫秒-3秒; SD，0.73秒）。对于3例脑灌注受损的患者，达到峰值的时间、上升时间和动脉与皮质之间的通过时间显著延长（>20、>9和>5秒）。在单个患者中，灌注损伤的程度可以通过正常和缺血组织之间的脑血流指数比值来量化。过境时间也反映了血流扰动动静脉fillas.CONCLUSION：ICG为基础的荧光血管造影定量似乎是有用的动脉通畅性和区域脑血流术中监测。
BACKGROUND: Intraoperative measurements of cerebral blood flow are of interest during vascular neurosurgery. Near-infrared indocyanine green (ICG) fluorescence angiography was introduced for visualizing vessel patency intraoperatively. However, quantitative information has not been available.OBJECTIVE: To report our experience with a microscope with an integrated dynamic ICG fluorescence analysis system supplying semiquantitative information on blood flow.METHODS: We recorded ICG fluorescence curves of cortex and cerebral vessels using software integrated into the surgical microscope (Flow 800 software; Zeiss Pentero) in 30 patients undergoing surgery for different pathologies. The following hemodynamic parameters were assessed: maximum intensity, rise time, time to peak, time to halfmaximal fluorescence, cerebral blood flow index, and transit times from arteries to cortex.RESULTS: For patients without obvious perfusion deficit, maximum fluorescence intensity was 177.7 arbitrary intensity units (AIs; 5-mg ICG bolus), mean rise time was 5.2 seconds (range, 2.9-8.2 seconds; SD, 1.3 seconds), mean time to peak was 9.4 seconds (range, 4.9-15.2 seconds; SD, 2.5 seconds), mean cerebral blood flow index was 38.6 AI/s (range, 13.5-180.6 AI/s; SD, 36.9 seconds), and mean transit time was 1.5 seconds (range, 360 milliseconds-3 seconds; SD, 0.73 seconds). For 3 patients with impaired cerebral perfusion, time to peak, rise time, and transit time between arteries and cortex were markedly prolonged (>20, >9, and >5 seconds). In single patients, the degree of perfusion impairment could be quantified by the cerebral blood flow index ratios between normal and ischemic tissue. Transit times also reflected blood flow perturbations in arteriovenous fistulas.CONCLUSION: Quantification of ICG-based fluorescence angiography appears to be useful for intraoperative monitoring of arterial patency and regional cerebral blood flow.