neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2015-0-1-41-45neurosurgery-145Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTПЕРВЫЙ ОПЫТ ПРИМЕНЕНИЯ ИНТРАОПЕРАЦИОННОЙ ИНФРАКРАСНОЙ ВИДЕОАНГИОГРАФИИ ПРИ КЛИПИРОВАНИИ ЦЕРЕБРАЛЬНЫХ АНЕВРИЗМThe first experience of intraoperative infrared videoangiography usage during cerebral aneurysms clippingКравецЛеонид ЯковлевичKravetsL. Ya.Lkravetz@yandex.ruНиколаевАндрей НиколаевичNikolaevA. N.andrey_nklv@yahoo.comФГБУ «Нижегородский НИИ травматологии и ортопедии» МЗ РФRussian FederationГородская клиническая больница № 13 Автозаводского районаRussian Federation201505102017014145Copyright © Кравец Л.Я., Николаев А.Н., 20172017Кравец Л.Я., Николаев А.Н.Kravets L.Y., Nikolaev A.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/145

Цель. Обзор результатов интраоперационной видеоангиографии с индоцианином зеленым (ICG-VA) при клипировании церебральных аневризм с выделением особенностей интерпретации получаемых данных в зависимости от времени введения контраста - до или после клипирования. Материал и методы. ICG-VA выполнена при операциях у 28 больных с церебральными аневризмами, среди которых 12 оперировано в остром периоде разрыва, 16 - в холодном. Методика реализовывалась с помощью операционного микроскопа OPMI Pentero с интегрированным модулем Infrared-800, который включался на выбранном этапе операции. Всего выполнено 34 исследования: 12 пациентам контраст вводили до клипирования, 22 - после. Результаты. Показана высокая информативность ICG-VA при ревизии области клипирования для определения проходимости несущих сосудов и перфорантов. Установлены различия в ангиографических признаках выключения аневризмы в зависимости от способа введения контраста. В частности, описана инверсия данных ICG-VA, указывающих на выключение аневризмы в случаях предварительного контрастирования сосудов, когда наложенный клипс может блокировать часть контраста попавшего в тело аневризмы, в то время как из несущих артерий он вымывается. Заключение. ICG-VA - оптимальная технология для объективной оценки адекватности клипирования церебральных аневризм. Следует учитывать особенности гемодинамики в исследуемой области до и после наложения временных или постоянных клипс. ICG-VA снижает риск потенциальных осложнений хирургии аневризм, в наших наблюдениях репозиция клипс понадобилась в 5 случаях.

Objective. To review the results of intraoperative indocyanine green videoangiography (ICG-VA) usage during clipping of cerebral aneurysms distinguishing the interpretation features of obtained data in accordance with time of contrast injection - before or after aneurysm clipping. Material and methods. We conducted ICG-VA at 28 patients with ruptured cerebral aneurysms among them 12 persons were operated on in acute period of hemorrhage and 16 patients - in delayed or cold period. This procedure was performed using operative microscope OPMI Pentero with plug-in Infrared-800 module, which was switched on at the certain stage of operation. There were 34 examination in total with contrast injection before aneurysm clipping in 12 cases and after clipping - 22 observations. Results. The high informative value of ICG-VA was demonstrated during revision of clipping site for patency determination of parent artery and perforating branches. The differences in angiographic signs of aneurysm elimination from blood flow depending on method of contrast injection were determined. The inversion of ICG-VA data was described in particular, indicating the aneurysm elimination in case of preliminary contrast of arteries, when applied clip may block some quantity of contrast in aneurysmal body whereas the contrast agent is washing out from parent vessels. Conclusion. ICG-VA is the optimal method for objective estimation of aneurysm clipping adequacy. The hemodynamics features in examined region before and after temporary or permanent clips placement must be taken into consideration. ICG-VA decreases the risk of possible complications in aneurysm surgery; the clip replacement was necessary in our 5 clinical observations.

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The authors declare that there are no conflicts of interest present.