脳血管外科手術における術中インドシアニングリーン蛍光血管撮影の応用―時間軸投影マップの有用性―:―時間軸投影マップの有用性―
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Surgical microscope-integrated near-infrared indocyanine green (ICG) video angiography in cerebrovascular surgery, which has recently made marked advances, has been accepted as a less-invasive, simple, real-time and repeatable technique. Several authors have reported the efficacy of ICG video angiography to evaluate the patency of normal cerebral blood vessels, the perfusion areas of extracranial-intracranial bypass flow and the complete interruption of abnormal blood flow, i.e., arteriovenous shunts. However, its findings have been demonstrated qualitatively in a gray-scale map, and it has been difficult to evaluate decreased vascular blood flow or angiographic circulation time quantitatively. Very recently, the FLOW 800® system has been developed. This system compiles the information from conventional ICG video angiography into a continuous color-scale map to identify the direction and sequence of vascular blood flow. In the present study, we assessed the validity of this novel method for cerebrovascular cases including 5-cerebral aneurysm clipping, 3-cerebral arteriovenous malformation (AVM) surgery, 2-carotid endarterectomy (CEA), and 1-moyamoya disease surgery using the Carl Zeiss Surgical Microscope OPMI® Pentero® integrated FLOW 800 system (Carl Zeiss Co., Tokyo, Japan). The direction and sequence of ICG fluorescence emitted from vascular blood flow was observed using the INFRARED 800® system as in the past. Moreover, vascular blood flow dynamics were demonstrated semi-quantitatively in color, using FLOW 800® system. The variation in blood flow over time was also visualized in each vasculature of interest. As a result, not only complete obliteration of the aneurysmal sac but the integrity of parent or branching vessels were clearly confirmed in vivid color images in cases of cerebral aneurysm surgery. Furthermore, the time-intensity curve of parent or branching vessels demonstrated a comparative diagram of the blood flow before and after clipping. In a cerebral AVM surgery, ICG video angiography and subsequent analysis of blood flow dynamics demonstrated normalization of the draining venous flow and the complete interruption of arteriovenous shunt in patients undergoing serial injection during AVM resection. In cases of CEA, the extent of carotid plaque and the patent post-sutured carotid artery were vividly demonstrated. In a moyamoya disease surgery, perfusion areas of direct bypass flow from the superficial temporal artery to the middle cerebral artery were clearly demonstrated in color. Based on these observations, real-time analysis of vascular blood flow dynamics prepared from ICG video angiography may be helpful to perform safe and steady operation in neurovascular cases.
- 一般社団法人 日本脳卒中の外科学会の論文
一般社団法人 日本脳卒中の外科学会 | 論文
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