微血管多普勒超声和吲哚菁绿血管造影联合监测在复杂颅内动脉瘤中的应用

Application of combined monitoring with microvascular doppler ultrasonography and indocyanine green angiography in complex intracranial aneurysms

目的探讨多种辅助监测技术——微血管多普勒超声(microvascular doppler ultrasonography,MDU)和吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在复杂颅内动脉瘤开颅手术中的应用价值。方法回顾分析2019-01—2020-12在徐州医科大学附属医院脑血管外科行开颅夹闭的30例复杂颅内动脉瘤患者的临床资料,术中均采用MDU及ICGA对载瘤血管及分支血管进行监测。结果术中MDU监测发现夹闭瘤颈后,载瘤动脉血流及分支血管异常3例,瘤颈夹闭不全1例,术中ICGA图像清晰,其中3例载瘤动脉及4例分支血管狭窄,经及时调整动脉瘤夹后无载瘤动脉狭窄,瘤颈夹闭完全,载瘤动脉显影良好。术后复查头颅CTA或DSA,与术中MDU、荧光造影结果一致。结论术中微血管多普勒超声联合吲哚菁绿荧光造影可无创、反复、准确地判断血管的形态及通畅性,值得在复杂颅内动脉瘤开颅夹闭术中推广。

Objective To investigate the value and significance of the application of combined monitoring with microvascular doppler ultrasonography(MDU)and indocyanine green angiography(ICGA)in complex intracranial aneurysms.Methods By performing a retrospective study,we aimed to evaluate the intraoperative value of combined monitoring with MDU and ICGA in complex intracranial aneurysms.From January 2019 to December 2020,30 patients with complex intracranial aneurysms who were to undergo aneurysm clipping were enrolled in the study.MDU and ICGA were used for intraoperative monitoring.Results All 30 patients complex intracranial aneurysms were successfully clipped.Intraoperative MDU monitoring found that after clipping the aneurysmal neck,the blood flow and branch vessels of the aneurysmal artery were abnormal in 3 cases,and the clipping of the aneurysmal neck was incomplete in 1 case.Intraoperative ICG images were clear,including 3 cases of parent artery stenosis and 4 cases of branch vessel stenosis.After timely adjustment of aneurysm clips,there was no aneurysmal artery stenosis,as well as,the aneurysm neck was completely clipped,and the aneurysmal artery was well developed.The results of CTA or DSA were consistent with those of MDU and ICGA.Conclusion Intraoperative microvascular Doppler ultrasound combined with indocyanine green fluorescence angiography can be used to determine vascular morphology and patency noninvasively,repeatedly and accurately,which is worthy of application in the clipping of complex intracranial aneurysms after craniotomy.