Abstract：
BACKGROUND: The use of fluorescent technologies in vascular neurosurgery emerged after indocyanine green video angiography (ICG-VA) was first described in 2003. As data supporting the efficiency of ICG in preventing postoperative complications has grown substantially, it has now established itself as the standard of care. However, the predominant literature centers on ICG techniques, leaving the evaluation of cost-effective fluorescein tools pending. We report the results of a prospective study in which we demonstrated the impact of intraoperative fluorescein videoangiography (FL-VA) in aneurysm surgery.
METHODS: Between December 2021 and September 2022, a total of 57 patients underwent craniotomy for intracranial aneurysm surgery. After aneurysm clipping, we administered a 0.5 mg/Kg of sodium fluorescein, and the intracranial area of interest was inspected through the microscope integrated module. The following data were collected: patient age and sex; number of clipped aneurysms; aneurysm location, size, and rupture status; Hunt Hess grade; intraoperative rupture; aneurysm calcification and thrombosed aneurysm; visualization of blood flow in perforating arteries; need for a clip adjustment after FL-VA analysis by neurosurgeon.
RESULTS: For the surgical clipping of 64 aneurysms in 57 patients, 80 FL-VA studies were performed. Clip adjustments were performed following FL-VA in 13 aneurysms. FL-VA had an impact on 20 % of the clipping. In seven aneurysms, clip adjustment was due to the \"presence of residual aneurysm\", in three cases due to the \"presence of neck\", and in three cases due to \"adjacent vessel stenosis\". Regarding the evaluation of flow in the perforating vessels, it was possible, with a good and detailed image in all cases.
CONCLUSIONS: The use of FL-VA has a significant impact in aneurysm surgery, enhancing effectiveness and safety. The dosage of 0.5 mg/kg administered is sufficient for assessing both aneurysm occlusion and the presence of flow in adjacent vessels.
METHODS: Between December 2021 and September 2022, a total of 57 patients underwent craniotomy for intracranial aneurysm surgery. After aneurysm clipping, we administered a 0.5 mg/Kg of sodium fluorescein, and the intracranial area of interest was inspected through the microscope integrated module. The following data were collected: patient age and sex; number of clipped aneurysms; aneurysm location, size, and rupture status; Hunt Hess grade; intraoperative rupture; aneurysm calcification and thrombosed aneurysm; visualization of blood flow in perforating arteries; need for a clip adjustment after FL-VA analysis by neurosurgeon.
RESULTS: For the surgical clipping of 64 aneurysms in 57 patients, 80 FL-VA studies were performed. Clip adjustments were performed following FL-VA in 13 aneurysms. FL-VA had an impact on 20 % of the clipping. In seven aneurysms, clip adjustment was due to the \"presence of residual aneurysm\", in three cases due to the \"presence of neck\", and in three cases due to \"adjacent vessel stenosis\". Regarding the evaluation of flow in the perforating vessels, it was possible, with a good and detailed image in all cases.
CONCLUSIONS: The use of FL-VA has a significant impact in aneurysm surgery, enhancing effectiveness and safety. The dosage of 0.5 mg/kg administered is sufficient for assessing both aneurysm occlusion and the presence of flow in adjacent vessels.
摘要：
背景：在2003年首次描述吲哚菁绿视频血管造影术（ICG-VA）之后，出现了在血管神经外科中使用荧光技术。随着支持ICG预防术后并发症效率的数据大幅增长，它现在已经确立了自己作为护理标准的地位。然而,主要文献集中在ICG技术上，尚待评估具有成本效益的荧光素工具。我们报告了一项前瞻性研究的结果，其中我们证明了术中荧光血管造影（FL-VA）在动脉瘤手术中的影响。
方法：在2021年12月至2022年9月之间，共有57例患者接受了颅内动脉瘤手术的开颅手术。动脉瘤夹闭后,我们服用了0.5mg/Kg的荧光素钠，并通过显微镜集成模块检查颅内感兴趣区域。收集以下数据：患者年龄和性别；夹闭动脉瘤的数量；动脉瘤位置，尺寸,和破裂状态；HuntHess分级；术中破裂；动脉瘤钙化和血栓形成的动脉瘤；穿孔动脉血流的可视化；神经外科医生进行FL-VA分析后需要进行夹子调整。
结果：对于57例患者的64个动脉瘤的手术夹闭，进行了80项FL-VA研究。在13个动脉瘤的FL-VA后进行夹子调整。FL-VA对20%的剪裁有影响。在七个动脉瘤中，夹子调整是由于“存在残留动脉瘤”，在三种情况下，由于“颈部的存在”，三例是由于“邻近血管狭窄”。关于射孔血管中流量的评估，有可能,在所有情况下都有良好和详细的图像。
结论：使用FL-VA在动脉瘤手术中具有重要影响，提高有效性和安全性。施用的0.5mg/kg的剂量足以评估动脉瘤闭塞和相邻血管中流动的存在。
方法：在2021年12月至2022年9月之间，共有57例患者接受了颅内动脉瘤手术的开颅手术。动脉瘤夹闭后,我们服用了0.5mg/Kg的荧光素钠，并通过显微镜集成模块检查颅内感兴趣区域。收集以下数据：患者年龄和性别；夹闭动脉瘤的数量；动脉瘤位置，尺寸,和破裂状态；HuntHess分级；术中破裂；动脉瘤钙化和血栓形成的动脉瘤；穿孔动脉血流的可视化；神经外科医生进行FL-VA分析后需要进行夹子调整。
结果：对于57例患者的64个动脉瘤的手术夹闭，进行了80项FL-VA研究。在13个动脉瘤的FL-VA后进行夹子调整。FL-VA对20%的剪裁有影响。在七个动脉瘤中，夹子调整是由于“存在残留动脉瘤”，在三种情况下，由于“颈部的存在”，三例是由于“邻近血管狭窄”。关于射孔血管中流量的评估，有可能,在所有情况下都有良好和详细的图像。
结论：使用FL-VA在动脉瘤手术中具有重要影响，提高有效性和安全性。施用的0.5mg/kg的剂量足以评估动脉瘤闭塞和相邻血管中流动的存在。
