動注蛍光脳血管撮影による脳表血流評価:─インドシアニン・グリーンとフルオレセインの3症例における比較検討─

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We evaluated the usefulness of intra-arterial fluorescence cerebral angiography (FCAG) from a catheter inserted into the external carotid artery (ECA) via the superficial temporal artery (STA) for detecting the blood flow in the small arteries, capillaries and small veins in the brain surface during neurological surgery. After indocyanine green (ICG) or fluorescein sodium (Fluorescein) was injected into the STA, fluorescein reached the intracranial internal carotid artery (ICA) through the common carotid artery or anastomoses between the ECA and ICA. Fluorescence in the vessels of brain surface was observed through a microscope and recorded on DVD image. In large arteries such as internal cerebral artery, images by FCAG using ICG were clearer than these by fluorescein-FCAG. On the other hand, in small arteries, capillaries and small veins in the brain surface, fluorescein-FCAG was superior to ICG-FCAG in resolution.Intra-arterial fluorescein-FCAG is very promising for estimation of the blood flow in the brain surface because it allows confirmation of delay and stagnation of capillary arterial blood flow on the brain surface. Based on our findings, we suggest that observation of the blood flow on the brain surface by fluorescein-FCAG is useful to prevent unexpected cerebral infarctions and to improve the surgical outcome.
一般社団法人日本脳卒中の外科学会の論文