吲哚菁绿荧光造影在脑和脊髓动静脉瘘手术中的应用

Application of fluorescence angiography by intravenous or intraarterial injection of ICG in management of brain and spinal arteriovenous fistulas

目的 探讨静脉内和选择性动脉内注射吲哚菁绿行术中荧光造影在脑和脊髓动静脉瘘手术中的应用价值.方法 共7例患者,其中前颅底硬脑膜动静脉瘘3例,脊髓硬脊膜动静瘘3例,髓周动静脉瘘1例.6例患者术中经静脉注射吲哚菁绿行术中荧光造影,1例髓周动静脉瘘患者先行选择性肋间动脉置管,再于术中经动脉行选择性吲哚菁绿荧光造影,在荧光造影辅助下确认瘘口及引流静脉后行夹闭或电凝切除,并重复行荧光造影观察,直至瘘口及动静脉瘘完全消除.结果 所有患者术中吲哚菁绿荧光造影均能清楚显示瘘口及引流静脉,所有患者随访期间症状改善,6例患者术后经血管造影证实动静脉瘘完全闭塞,1例患者MRI显示髓周血管流空影和脊髓水肿消失.结论 术中吲哚菁绿荧光造影实施简便,可实时动态观察动静脉瘘血流动力学特征,经动脉选择性荧光造影具有造影剂用量小、背景清楚、便于多次重复等优点,可为复杂动静脉瘘手术提供更精确的影像.

Objective To investigate the experiences and efficacy of intraoperative fluorescence angiography in treating brain and spinal arteriovenous fistulas by intravenous or intraarterial injection of indocyanine green （ICG）.Methods Seven patients underwent microsurgical treatment for brain or spinal arteriovenous fistulas with the assistance of ICG fluorescence angiography.Among these 7 patients,there were three with anterior cranial dual arteriovenous fistulae,three with spinal dural arteriovenous fistulae,and one with perimedullary arteriovenous fistulae.For fluorescence angiography,ICG was injected intravenously in six patients,and intraarterially in the remaining patient of complex perimedullary arteriovenous fistulae after selective catheterization.Then surgical obliteration of the fistulas were obtained and confirmed by ICG fluorescence angiography.Results Intraoperative ICG fluorescence angiography confirmed the obliteration of the fistulous points in all patients.In follow-up,complete occlusion of the fistulas were found by digital subtraction angiography in six patients.Obvious resolution of the vascular flow voids and spinal code edema was observed by MRI in one patient.Conclusions Intraoperative ICG fluorescence angiography for surgery was useful for brain and spinal arteriovenous fistulas by providing information on vascular dynamics directly.Selective intraarterial ICG fluorescence angiography may be more valuable in treating complex lesions for feasibility of multiple repeated injections angiography and clear images.