The usefulness of indocyanine green during surgery for hypervascular posterior fossa tumors.
The usefulness of indocyanine green during surgery for hypervascular posterior fossa tumors.
复制标题
DOI：
10.4103/sni.sni_19_18
复制
发表时间：
2018
影响因子：
--
通讯作者：
Ishiuchi S
中科院分区：
文献类型：
--
作者：
Shinya T;Nagamine H;Sugawara KI;Ishiuchi S
脑血管母细胞瘤是一种良性肿瘤，血流丰富，主要发生在后颅窝。由于出血的风险，肿瘤整块切除在外科治疗中很重要;然而，实际上在实践中相当困难。因此，我们提出了一种利用吲哚菁绿色（ICG）可视化后颅窝富血管肿瘤的手术策略。病例1涉及一名有von Hippel-Lindau（VHL）病史的48岁男性。磁共振成像（MRI）显示右侧桥小脑角有一个直径为3.0 cm的实体瘤。我们做手术是因为肿瘤压迫脑干。手术通过后颞下经小脑幕入路进行，以便术中显示供血动脉和引流静脉。通过ICG确认血管，并整块切除肿瘤。病例2涉及一名30岁女性。注意到颅内压升高的体征，MRI显示左小脑半球直径3.5 cm的实体瘤。手术经中线枕下入路进行。同样，我们使用ICG确认血管，并整块切除肿瘤。对于后颅窝富血供的肿瘤，术前影像学评估很重要。此外，在手术过程中使用ICG对于手术策略是有利的，其中供血动脉和引流静脉存在于手术区域的表面，因此更容易整体去除。
Cerebral hemangioblastomas are benign tumors with abundant blood flow that occur mainly in the posterior fossa. Tumor removal en bloc is important in surgical treatment because of the risk of bleeding; however, it is actually rather difficult in practice. Therefore, we propose a surgical strategy for visualizing hypervascular tumors of the posterior fossa utilizing indocyanine green (ICG). Case 1 involved a 48-year-old male with a history of von Hippel–Lindau (VHL) disease. Magnetic resonance imaging (MRI) revealed a solid tumor measuring 3.0 cm in diameter in the right cerebellopontine angle. We performed surgery because the tumor was pressing against the brainstem. Surgery was performed via the posterior subtemporal transtentorial approach in order to visualize the feeding artery and draining vein intraoperatively. The vessels were confirmed by ICG and the tumor was removed en bloc. Case 2 involved a 30-year-old woman. Signs of increased intracranial pressure were noted, and an MRI revealed a solid tumor 3.5 cm in diameter in the left cerebellar hemisphere. Surgery was performed via the midline suboccipital approach. Similarly, we confirmed the vessels using ICG and the tumor was removed en bloc. For hypervascular tumors of the posterior fossa, preoperative image assessment is important. Furthermore, the use of ICG during surgery is advantageous for surgical strategies where the feeding arteries and draining veins exist superficially in the operative field and are therefore easier to remove en bloc.