CAJ | 학술논문

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.
목적 탐토정맥내화선택성동맥내주사신타정록행술중형광조영재뇌화척수동정맥루수술중적응용개치.방법 공7례환자,기중전로저경뇌막동정맥루3례,척수경척막동정루3례,수주동정맥루1례.6례환자술중경정맥주사신타정록행술중형광조영,1례수주동정맥루환자선행선택성륵간동맥치관,재우술중경동맥행선택성신타정록형광조영,재형광조영보조하학인루구급인류정맥후행협폐혹전응절제,병중복행형광조영관찰,직지루구급동정맥루완전소제.결과 소유환자술중신타정록형광조영균능청초현시루구급인류정맥,소유환자수방기간증상개선,6례환자술후경혈관조영증실동정맥루완전폐새,1례환자MRI현시수주혈관류공영화척수수종소실.결론 술중신타정록형광조영실시간편,가실시동태관찰동정맥루혈류동역학특정,경동맥선택성형광조영구유조영제용량소、배경청초、편우다차중복등우점,가위복잡동정맥루수술제공경정학적영상.
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.