吲哚菁绿血管造影在动脉瘤术中对穿通支血管保护的应用

Application of indocranine green angiography in protecting perforating artery during intracranial aneurysm surgery

目的探讨吲哚菁绿血管造影在颅内动脉瘤手术中对穿通支血管的保护作用。方法回顾性总结26例颅内动脉瘤术中暴露动脉瘤及夹闭动脉瘤后进行吲哚菁绿血管造影,观察动脉瘤、载瘤动脉及周围穿通支血管在夹闭前后的分布及显影情况,据此调整动脉瘤夹及评价手术满意与否。结果术中共进行吲哚菁绿血管造影48次,3例各造影3次,夹闭后造影发现有穿通支被阻断,术中及时变换动脉瘤夹位置。术后全部复查头颅CT,没有出现穿通支血管损伤导致的缺血性脑梗死或功能障碍。结论对穿通支血管的走行、分布、供应范围的深入理解及术中有效保护的同时,辅以吲哚菁绿血管造影,能够直观、即时、快速的判断穿通支血管是否通畅,有效保护穿通支血管,提高手术质量,改善患者预后。

Objective To explore the protection of perforating artery of intraoperative indocranine green angiography （ICGA） in the treatment of intracranial aneurysm. Method The clinical data of 26 patients with intracranial aneurysms were analyzed retrospectively. Intraoperative ICGA was performed before and right after the clipping. The vessels in the surgical field were observed with the fluorescence microscope. The effect of intraoperative ICGA in intracrania aneurysm surgery to protect perforating artery was evaluated. Results All the patients underwent aneurysm clipping, and ICGA were performed for 48 times. 3 patients each underwent ICGA for 3 times, intraoperative ICGA was performed before and right after the clipping, we found that the perforating arteries were blocked, so mmediately the aneurysm clips were adjusted. All the patients underwent CT scanning and none had ischemic infarction and disorders of nervous functions postoperatively. Conclusions The understanding of the distribution, supplying territory, and clinical manifestation of important perforating arteries is paramount importance. Effective protection and correct management of perforating arteries play an important role in the surgical outcome. And with the assist of ICGA in the treatment of intracranial aneurysm, it can directly and rapidly judge whether the perforating artery is unobstructed. It comes true that ICGA is an important method in the surgery of intracranial aneurysm.