Use of Microscope‐Integrated Near‐Infrared Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arteriovenous Fistulae
Use of Microscope‐Integrated Near‐Infrared Indocyanine Green Videoangiography in the Surgical Treatment of Spinal Dural Arteriovenous Fistulae
复制标题
显微镜集成近红外吲哚菁绿视频血管造影在硬脊膜动静脉瘘的手术治疗中的应用
DOI：
10.1227/01.neu.0000368108.94233.22
复制
发表时间：
2010
期刊：
影响因子：
4.8
通讯作者：
R. Spetzler
中科院分区：
文献类型：
--
作者：
R. Hanel;P. Nakaji;R. Spetzler
在硬脊膜动静脉瘘（dAVF）的手术治疗中，识别和完全阻断瘘是必要的，但并不总是明显的。我们检查了一些病例，在这些病例中，我们借助显微镜整合的近红外吲哚菁绿色（ICG）视频血管造影术识别并确认了脊柱dAVF的手术闭塞。方法在6例硬膜内背侧AVF（I型）中断的6次手术中进行了视频血管造影。包含红外激发光的手术显微镜集成光源照亮手术区域，并用于可视化ICG的静脉推注。将瘘管、供血动脉和引流静脉的位置以及瘘管闭塞的记录与术前和术后数字减影血管造影的结果进行比较。所有6例患者经术后即刻选择性脊髓血管造影证实，经TSCCG视频血管造影确定了瘘点、供血动脉和引流静脉。在1例病例中，术中ICG排除了术前血管造影怀疑的邻近节段的其他可疑瘘。结论显微镜下ICG视频血管造影操作简单，可提供脊髓dAVF精确定位的实时信息。在脊柱dAVF手术中，该技术可作为一种独立的血管造影术或作为术中或术后数字减影血管造影术的辅助手段。需要更大的系列来确定使用这种方式是否可以减少硬膜内背侧动静脉瘘闭塞后立即进行脊髓血管造影的需要。
OBJECTIVEIdentification and complete interruption of fistulae are essential but not always obvious during the surgical treatment of spinal dural arteriovenous fistulae (dAVFs). We examined cases in which we identified and confirmed surgical obliteration of a spinal dAVF with the aid of microscope-integrated near-infrared indocyanine green (ICG) videoangiography. METHODSICG videoangiography was performed during 6 surgical interventions in which 6 intradural dorsal AVFs (type I) were interrupted. An operating microscope-integrated light source containing infrared excitation light illuminated the operating field and was used to visualize an intravenous bolus of ICG. The locations of fistulae, feeding arteries, and draining veins and documentation of occlusion of the fistulae were compared with findings on preoperative and postoperative digital subtraction angiography. RESULTSICG videoangiography identified the fistulous point(s), feeding arteries, and draining veins in all 6 cases, as confirmed by immediate postoperative selective spinal angiography. In 1 case, intraoperative ICG ruled out an additional questionable fistula at a contiguous level suspected on the preoperative angiography. CONCLUSIONMicroscope-based ICG videoangiography is simple and provides real-time information about the precise location of spinal dAVFs. During spinal dAVF surgery, this technique can be useful as an independent form of angiography or as an adjunct to intra or postoperative digital subtraction angiography. Larger series are needed to determine whether use of this modality could reduce the need for immediate postoperative spinal angiography after obliteration of intradural dorsal AVFs.