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首页> 外文期刊>Neurosurgical focus >Application of indocyanine green video angiography in parasagittal meningioma surgery
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Application of indocyanine green video angiography in parasagittal meningioma surgery

机译：吲哚菁绿视频血管造影在矢状旁脑膜瘤手术中的应用

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Object: There are no doubts about the role that indocyanine green video angiography (ICGVA) can play in current vascular neurosurgery. Conversely, in brain tumor surgery, and particularly in meningioma surgery, this role is still unclear. Vein management is pivotal for approaching parasagittal meningiomas, because venous preservation is strictly connected to both extent of resection and clinical outcome. The authors present the technical traits and the postoperative outcome of the application of ICGVA in patients undergoing parasagittal meningioma surgery. Methods: The authors retrospectively collected demographic, radiological, intraoperative, and follow-up data in 43 patients with parasagittal meningiomas who underwent surgery with the assistance of ICGVA at Padua Neurosurgical Department between October 2010 and July 2013. Intraoperative ICGVA findings at different stages (before dural opening, after dural opening, during resection, after resection) were reviewed. Additional data on functional monitoring, temporary venous clipping, and flow measurements were also recorded. The overall postoperative outcome was evaluated by assessing both the extent of resection and the clinical outcome data. Results: The ICGVA studies were performed 125 times in 43 patients, providing helpful data for vein management and tumor resection in all stages of surgery. In 16% of meningiomas completely occluding the superior sagittal sinus, the ICGVA data differed from radiological findings and changed the surgical approach. In 20% of cases the intraoperative ICGVA findings directly guided the surgical strategy: venous sacrifice was necessary in 7 cases, without postoperative consequences; temporary clipping with neurophysiological monitoring proved to be predictive of safe venous sacrifice. In 7% of cases the ICGVA data needed to be supplemented with flow measurements. Simpson Grade I-II and Grade III resections were achieved in 86% and 14% of cases, respectively, with a 4.6% rate of overall morbidity. Conclusion: This study shows that ICGVA can assist the different stages of parasagittal meningiomas surgery, guiding the vein management and tumor resection strategies with a favorable final clinical outcome. However, in the authors' experience the use of other complementary tools was mandatory in selected cases to preserve functional areas. Further studies are needed to confirm that the application of ICGVA in parasagittal meningioma surgery may improve the morbidity rate, as reported in this study.
机译：目的：毫无疑问，吲哚菁绿色视频血管造影（ICGVA）在当前的血管神经外科手术中可以发挥的作用。相反，在脑肿瘤手术中，特别是在脑膜瘤手术中，这一作用尚不清楚。静脉处理对于接近矢状旁脑膜瘤至关重要，因为静脉保存与切除范围和临床结局密切相关。作者介绍了在接受矢状旁矢状脑膜瘤手术的患者中应用ICGVA的技术特点和术后结果。方法：作者回顾性收集2010年10月至2013年7月在帕多瓦神经外科进行ICGVA辅助手术的43例矢状旁脑膜瘤患者的人口统计学，放射学，术中和随访数据。术中ICGVA在不同阶段的发现（之前硬膜外开放，硬膜外开放后，切除过程中，切除后）进行了回顾。还记录了有关功能监测，临时静脉钳夹和流量测量的其他数据。通过评估切除范围和临床结果数据来评估总体术后结果。结果：ICGVA研究共对43例患者进行了125次研究，为所有手术阶段的静脉管理和肿瘤切除提供了有用的数据。在16％的脑膜瘤完全闭塞了上矢状窦，ICGVA数据与放射学结果有所不同，并改变了手术方式。在20％的病例中，术中ICGVA的发现直接指导了手术策略：7例中有必要进行静脉处死，而无术后后果。神经生理学监测的临时钳夹被证明可以安全地牺牲静脉。在7％的情况下，ICGVA数据需要补充流量测量。分别在86％和14％的病例中实现了I-II级和III级的Simpson切除，总体发病率为4.6％。结论：这项研究表明，ICGVA可以辅助矢状旁脑膜瘤手术的不同阶段，指导静脉治疗和肿瘤切除策略，并具有良好的最终临床效果。但是，根据作者的经验，在某些情况下必须使用其他辅助工具来保留功能区域。正如本研究报道的那样，需要进一步的研究来证实ICGVA在矢状旁脑膜瘤手术中的应用可以提高发病率。

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