中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2011年
1期
40-43
,共4页
苏伟%冯恩山%王贵怀%王德江%曹勇%贾文清%马骏%马光铄
囌偉%馮恩山%王貴懷%王德江%曹勇%賈文清%馬駿%馬光鑠
소위%풍은산%왕귀부%왕덕강%조용%가문청%마준%마광삭
硬脊膜动静脉瘘%吲哚菁绿%血管造影术
硬脊膜動靜脈瘺%吲哚菁綠%血管造影術
경척막동정맥루%신타정록%혈관조영술
Spinal dural arteriovenous fistula%Indocyanine green%Angiography
目的 探引哚菁绿术中荧光造影术在脊髓硬脊膜动静脉瘘手术中的作用.方法 9例脊髓硬脊膜动静咏瘘患者,均经脊髓DSA确诊,行后正中全椎板切开,术中吲哚菁绿荧光造影明确供血动脉、引流静脉及瘘口,夹闭瘘口并选择性切除静脉血管畸形.结果 畸形血管位于颈段1例、胸段4例、胸腰段2例、腰段1例、胸腰骶段1例;介入栓塞不充分后转手术1例,介入栓塞微导管难以到位转手术8例;术后MRI显示髓周异常迂曲畸形血管消失,脊髓缺血水肿好转.术后症状消失2例,改善6例,无变化1例.结论 吲哚菁绿术中荧光造影能够明确供血动脉、引流静脉及瘘口情况,有效地提高了脊髓硬脊膜动静脉瘘手术的疗效.
目的 探引哚菁綠術中熒光造影術在脊髓硬脊膜動靜脈瘺手術中的作用.方法 9例脊髓硬脊膜動靜詠瘺患者,均經脊髓DSA確診,行後正中全椎闆切開,術中吲哚菁綠熒光造影明確供血動脈、引流靜脈及瘺口,夾閉瘺口併選擇性切除靜脈血管畸形.結果 畸形血管位于頸段1例、胸段4例、胸腰段2例、腰段1例、胸腰骶段1例;介入栓塞不充分後轉手術1例,介入栓塞微導管難以到位轉手術8例;術後MRI顯示髓週異常迂麯畸形血管消失,脊髓缺血水腫好轉.術後癥狀消失2例,改善6例,無變化1例.結論 吲哚菁綠術中熒光造影能夠明確供血動脈、引流靜脈及瘺口情況,有效地提高瞭脊髓硬脊膜動靜脈瘺手術的療效.
목적 탐인타정록술중형광조영술재척수경척막동정맥루수술중적작용.방법 9례척수경척막동정영루환자,균경척수DSA학진,행후정중전추판절개,술중신타정록형광조영명학공혈동맥、인류정맥급루구,협폐루구병선택성절제정맥혈관기형.결과 기형혈관위우경단1례、흉단4례、흉요단2례、요단1례、흉요저단1례;개입전새불충분후전수술1례,개입전새미도관난이도위전수술8례;술후MRI현시수주이상우곡기형혈관소실,척수결혈수종호전.술후증상소실2례,개선6례,무변화1례.결론 신타정록술중형광조영능구명학공혈동맥、인류정맥급루구정황,유효지제고료척수경척막동정맥루수술적료효.
Objective To evaluate the clinical significance of intraoperative indocyanine green (ICG)videoangiography in surgical management of spinal dural ateriovenots fistulae (dAVFs).Method In this retrospective analysis we examined nine cases of dAVFs, diagnosed by complete spinal angiography,in which laminoplasty were performed through posterior approach.An operating microscope - integrated light source containing infrared excitation light illuminated the operating field and was used to visualize an intravenous bolus of ICG.The locations of fistulae, feeding arteries and draininig veins were identified and compared before and after surgical obhteration by intraoperative ICG videoangiography.Results In the nine cases the dAVFs involved one cervical cord, four thoracic cord,two thoracic lumbar cord, one lumbar cord and one thoracic and lumbosacral cord.One of them used to take an unsuccessful endovascular embolization, while the rest of them were given the operation right after diagnosed by the spinal angiography.Microscope-based ICG videoangiography identified the fistulous point(s),feeding arteries and draining veins in all nine cases,as confirmed by postoperative MRI which showed complete obliteration of the dAVFs with improved spinal blood supply and reduced spinal cord edema.After the operation the clini cal symptoms were nearly disappered in two cases, improved in six cases, and present no obvious changes in one case.Conclusions Intraoerative ICG videoangiography provides real -time information about the precise location of spinal dAVFs,the feeding arteries and the draining veins, as well as additional feeding aiteries unrevealed by the preoperative spinal angiography and residue pathologic blood vessels during the operation, which efficiently improves the surgical outcomes and prognosis.