摘要
目的 探讨神经导航、术中电生理监测及吲哚氰绿（ICG）荧光造影在脑动静脉畸形（AVM）显微外科手术中的临床应用.方法 回顾性分析解放军总医院神经外科2009年1月至2015年2月行显微外科手术的42例脑AVM患者资料,男性29例,女性13例,年龄4～62岁,平均32.6岁.42例患者均在神经导航辅助下切除病变,对于靠近运动区的AVM,术中结合电生理监测,在切开硬脑膜暴露畸形血管团、夹闭可疑供血动脉及切除畸形血管团后进行术中ICG荧光造影,采用ICG分析软件重建术区血管的可视化图像,判断供血动脉、引流静脉和畸形血管团.术后1周复查脑血管数字减影血管造影,判断有无畸形血管团残留.采用Rankin评分法（修订版）对患者的功能状态进行随访评估.结果 42例脑AVM患者中,85.7％（36/42）的患者获得全部切除.其中18例涉及功能区有畸形血管团的患者中,14例脑AVM被全部切除;24例未涉及功能区的畸形血管团的患者中,22例AVM被全部切除.11例患者完成40次术中ICG荧光造影,每例平均3.6次（3～6次）.通过术中ICG荧光造影,10例能辨认出畸形团的供血动脉,9例能辨认出引流静脉,11例能辨认出畸形团.37例患者获得随访,平均22.5个月（3～70个月）,31例（83.8％）患者术后可重返日常生活和工作（Rankin评分≤2）.结论 术前选择合适的AVM病例,在多种技术包括神经导航、电生理监测和荧光造影辅助下行显微外科手术治疗,可在有效切除畸形血管团的同时保留神经功能.
Objective To explore the clinical useness of intraoperative functional neuronavigation and fluorescent indocyanine green （ICG） angiography as well as electrophysiological evaluation during microsurgical resection of cerebral arteriovenous malformations （AVM）.Methods A series of 42 consecutive cases with AVM underwent microsurgery by intraoperative functional neuronavigation at Department of Neurosurgery of People＆#39;s Liberation Army General Hospital from January 2009 to February 2015 were retrospectively analyzed.Of the 42 patients,29 were males and 13 were females aging from 4 to 62 years （mean age 32.6 years）.Preoperative assessment included functional magnetic resonance imaging and diffusion tensor imaging to identify the relationship between lesions and eloquent areas.The results of images were integrated into three-dimensional datasets to achieve intraoperative microscopic-based functional neuronavigation during AVM resection.Operations involved in motor areas and corticospinal tract were performed under continuous electrophysiological monitoring.ICG angiography was performed at predissection,post-clipping of the feeders,and post-resection of the nidus.FLOW 800 software presented a color map and ICG intensity-time curve to demostrate the vascular architecture.Postoperative digital subtraction angiography was re-examined routinely to evaluate the extent of resection.Clinical outcomes were evaluated with the modified Rankin Scale.Results All patients underwent surgery under intraoperative navigation.Of the 42 patients,total resection was achieved in 36 cases （85.7%,36/42） including 14 cases of AVM in eloquent areas.A total of 40 ICG angiographies were successfully performed among 11 patients.Average number of ICG injections per operation was 3.6 （ranging from 3 to 6）.Feeders were visualized in 10 patients and drainers were visualized in 9 cases.The post-surgical follow-up period varied from 3 months to 70 months （mean 22.5 months）.83.8% of the patients returned to normal work and li
出处
《中华外科杂志》
CAS
CSCD
北大核心
2017年第5期389-393,共5页
Chinese Journal of Surgery
关键词
脑动静脉畸形
神经导航
荧光造影
电生理监测
显微外科手术
Intracranial arteriovenous malformations
Neuronavigation
Fluorescent indocyanine green angiography
Electrophysiology
Microsurgery
