摘要:
Objective To investigate the role of indocyanine green( ICG) fluorescence imaging in craniotomy aneurysm clipping. Methods A retrospective study was performed on 58 cases of patients with intracranial aneurysm who were admitted and treated by craniotomy from March 2013 to March 2015. ICG fluorescence angiography was used in 26 cases during operation( imaging surgery group) and no intraopera-tive ICG fluorescence angiography was performed in 32 cases ( conventional surgery group ) . Through ICG fluorescence angiography to assist determine clipping position by evaluating the direction of aneurysm,size of occlusion,and the blood supply of its parent artery. The coma scale of the patients was evaluated by the glass coma scale( GCS) ,and the postoperative cerebral ischemia and aneurysm residual were compared be-tween the two groups. Results All patients were followed up by 3 to 10 months. GCS score of the imaging surgery group,25 cases in level 1,and 1 case in level 2. GCS score of the conventional surgery group,29 ca-ses in level 1,and 3 cases in level 2. The incidence of cerebral ischemia and residual aneurysm in the ima-ging surgery group was significantly lower than that in the conventional surgery group,and the difference was statistically significant ( P<0. 05 ) . Conclusion The technique of intracranial aneurysm ICG imaging is simple and easy to operate. It has features of ideal spatial resolution and temporal resolution,high safety,and strong repeatability. By providing important information about whether aneurysm neck is completely closed, whether the parent artery is stenotic,and whether important branches of artery are open.%目的 探讨开颅动脉瘤夹闭术中吲哚菁绿(ICG)荧光血管造影在手术应用中的价值.方法 选取2013年3月至2015年3月齐齐哈尔市第一医院神经外科收治的58例动脉瘤患者.术中应用ICG荧光造影26例(造影手术组),术中未采用ICG荧光造影32例(常规手术组).通过术中ICG荧光造影评估动脉瘤方向、大小夹闭情况和载瘤动脉的供血情况,根据造影结果改变动脉瘤夹位置.采用格拉斯昏迷评分量表(GCS)对患者的昏迷程度进行评估,并比较两组患者术后脑缺血和动脉瘤残留情况.结果 对所有患者随访3~10个月,造影手术组GCS评分,第1级25例,第2级1例.常规手术组GCS评分,第1级29例,第2级3例.造影手术组的患者术后脑缺血和动脉瘤残留的发生率明显低于常规手术组,差异均有统计学意义(P<0.05).结论 开颅动脉瘤夹闭术术中ICG荧光血管造影设备简便,操作易行,具有理想的空间分辨率和时间分辨率,且安全性高、可重复性强,对术中判断是否完全夹闭动脉瘤颈、载瘤动脉是否狭窄情况、重要分支是否通畅等情况提供重要的参考依据.