| 摘要 |
Background: Both indocyanine green videoangiography (ICG‑VA) and flowmetry were considered beneficial
in preventing parent artery compromise during aneurysm surgery. However, the appropriate strategy that
should be used remains controversial. The objective of the study is to assess the outcomes of aneurysm
clipping through flowmetry or ICG‑VA monitoring.
Materials and Methods: This retrospective cohort study included 75 patients who underwent aneurysm
clipping with vascular patency monitoring. In total, 42 patients underwent flowmetry monitoring and 33
ICG‑VA monitoring. Preoperative disease severity and functional outcomes were assessed using the World
Federation of Neurosurgical Societies (WFNS) grading system and the modified Rankin scale, respectively.
Results: As compared with ICG‑VA, flowmetry group had nonsignificant higher incidence of clip
modification (31.7% vs. 18.2%, P = 0.29) and residual neck (22% vs. 10%, P = 0.218). Besides Fisher grade,
flowmetry monitoring (Crude odds ratio [OR] = 0124, P = 0.015), young age, and anterior communicating
artery location were the independent risk factors for vasospasm based on multivariate analysis. The incidence
of parent artery compromise did not differ between both groups. Old age, poor preoperative WFNS grade,
low Glasgow coma scale (GCS) score, left‑side location, and long hospital stay were associated with poor
functional outcomes in the univariate analysis. However, only the GCS score was considered a prognostic
factor in the multivariate analysis (Adjusted OR = 0.03, P = 0.034).
Conclusion: Both monitoring methods have similar functional outcomes. Although not influencing outcome,
the flowmetry group has a higher incidence of angiographic vasospasm than the ICG‑VA group. The vessel
preparation for flowmetry monitoring is more complicated than that for ICG‑VA; thus, we recommend
ICG‑VA for routine monitoring. Flowmetry may be applicable in distal aneurysms when hemodynamic
insufficiency in a parent artery is suspected. |
| 關鍵詞 |
Cerebral aneurysm, angiography, clipping, flowmetry, indocyanine green videoangiography, residual aneurysm, subarachnoid hemorrhage, vasospasm, World Federation of Neurosurgical Societies grade, fluorescence image |
