术中彩色多普勒结合荧光造影在脑动静脉畸形手术中的应用

Intraoperative color Doppler and indocyanine green angiography for cerebral arteriovenous malformations during microsurgery

目的探讨术中彩色多普勒结合吲哚菁绿血管造影在脑动静脉畸形(cAVM)手术的应用价值。方法回顾性分析46例cAVM的临床资料。手术切除cAVM过程中,使用彩色多普勒探查以确定畸形血管团位置和供血动脉来源,并与术前CTA对比。同时使用吲哚菁绿进行术中荧光造影,观察畸形血管团血流方向,以辨认浅表供血动脉及引流静脉。手术切除畸形血管后再行多普勒及荧光造影检查以评估手术效果。结果 46例病人术中彩色多普勒所示病变定位与术前CTA一致,术中彩色多普勒对深部供血动脉分辨良好,但8例(17.4%)病变血管在彩色多普勒下难以发现。荧光造影对浅表血管血液流向分辨清晰,手术切除畸形血管团完全。术后病人出现轻度神经功能损害6例,经术后康复锻炼后无明显后遗症,其他病人神经功能保留良好。结论术中彩色多普勒结合吲哚菁绿荧光造影对cAVM术中定位、供血动脉及引流静脉有良好的实时判断价值,有助于确定手术切除方案,准确切断供血动脉,减少术中出血及手术副损伤,降低术后畸形血管团残留率。

Objective To investigate the value of intraoperative color Doppler combined with indocyanine green angiography（ICGA） in excision of cerebral arteriovenous malformation（cAVM）.Methods The clinical data of 46 patients with confirmed cAVM was analyzed retrospectively.The location of the cAVM and the feeding artery were explored by the color Doppler during the surgical resection,and the results were compared with the findings by preoperative CT angiography（CTA）.Meanwhile,ICGA was used to observe the blood flow of the cAVM and to confirm the superficial feeding arteries and draining veins.Then the surgical outcomes were assessed by color Doppler and ICGA after surgical removal.Results The findings by intraoperative color Doppler were consistent with the results from preoperative CTA in 46 patients,and the Doppler examination showed a good resolution of the deep feeding artery,but lesion vessels were difficult to find under color Doppler in 8（17.4%）.ICGA showed clear superficial vascular blood flow.All patients achieved complete resection of the malformation.Mild nerve dysfunction appeared in 6 patients postoperation and recovered after rehabilitation exercise,and the remaining patients retained good neurological function.Conclusions Intraoperative color Doppler in combination with ICGA could locate the cAVM,real-time judge the feeding arteries and draining veins,thus helping the surgeon to design the removal program based on which feeding artery can be cut off and to reduce intraoperative bleeding,injury to the brain parenchyma and postoperative residual rate of cAVM.