Surgical Hyperspectral imaging and Indocyanine green Near-infrared Examination (SHINE) for brain arteriovenous malformation resection: a case report on how to visualize perfusion.

IF 1.6 4区 医学 Q2 SURGERY Frontiers in Surgery Pub Date : 2024-10-18 eCollection Date: 2024-01-01 DOI:10.3389/fsurg.2024.1477920
Johannes Wach, Ferdinand Weber, Martin Vychopen, Felix Arlt, Annekatrin Pfahl, Hannes Köhler, Andreas Melzer, Erdem Güresir
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Abstract

Background and importance: Arteriovenous malformations (AVMs) are complex vascular anomalies that pose significant risks, including intracranial hemorrhage and neurological deficits. Surgical resection is the preferred treatment, requiring precise intraoperative imaging to ensure complete removal while preserving critical structures. This case report presents the first combined use of hyperspectral imaging (HSI) and indocyanine green video angiography (ICG VA) to visualize perfusion during brain AVM surgery, highlighting the potential benefits of these advanced imaging techniques.

Case description: A 66-year-old male presented with chronic headaches but no neurological deficits. MRI revealed a superficial AVM in the left frontal lobe within the superior frontal sulcus, measuring approximately 2.4 cm. The AVM was fed by feeders from the pericallosal artery, callosomarginal artery, and middle cerebral artery (MCA) branches, with drainage through a dilated cortical vein into the superior sagittal sinus. Preoperative embolization of two MCA feeding branches was performed, followed by microsurgical resection with ICG VA and HSI.

Conclusions: This case report demonstrates the successful application of HSI and ICG VA in brain AVM surgery. The combined use of these technologies provided comprehensive intraoperative assessment, enhancing surgical precision and safety. The integration of HSI offers non-invasive, contrast-agent-free imaging, potentially improving outcomes by enabling detailed perfusion mapping. Future studies should explore the broader applications of these imaging modalities in neurovascular practice.

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用于脑动静脉畸形切除术的外科高光谱成像和吲哚菁绿近红外检查(SHINE):关于如何观察灌注的病例报告。
背景和重要性:动静脉畸形(AVM)是一种复杂的血管畸形,具有颅内出血和神经功能障碍等重大风险。手术切除是首选的治疗方法,需要精确的术中成像以确保完全切除,同时保留关键结构。本病例报告首次联合使用了高光谱成像(HSI)和吲哚青绿视频血管造影(ICG VA)来观察脑动静脉畸形手术过程中的灌注情况,凸显了这些先进成像技术的潜在优势:一名 66 岁的男性患有慢性头痛,但无神经功能障碍。核磁共振成像显示,左侧额叶上额沟内有一个浅表的动静脉畸形,大小约 2.4 厘米。动静脉畸形由胼胝体周围动脉、胼胝体边缘动脉和大脑中动脉(MCA)分支供血,通过扩张的皮质静脉引流至上矢状窦。术前对两支 MCA 供血分支进行了栓塞,随后用 ICG VA 和 HSI 进行了显微手术切除:本病例报告展示了 HSI 和 ICG VA 在脑动静脉畸形手术中的成功应用。这些技术的联合使用提供了全面的术中评估,提高了手术的精确性和安全性。HSI 的整合提供了无创、无造影剂的成像,通过绘制详细的灌注图有可能改善手术效果。未来的研究应探索这些成像模式在神经血管实践中的更广泛应用。
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来源期刊
Frontiers in Surgery
Frontiers in Surgery Medicine-Surgery
CiteScore
1.90
自引率
11.10%
发文量
1872
审稿时长
12 weeks
期刊介绍: Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.
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