ĐẶC ĐIỂM HÌNH ẢNH HỌC VÀ ỨNG DỤNG HUỲNH QUANG TRONG MỔ ĐIỀU TRỊ PHẪU THUẬT TÚI PHÌNH ĐỘNG MẠCH NÃO TUẦN HOÀN TRƯỚC VỠ TẠI BỆNH VIỆN TRƯỜNG ĐẠI HỌC Y HÀ NỘI

Abstract

Objective: To evaluate the preoperative imaging characteristics and the results of intraoperative fluoroscopy (ICG) combined with microsurgery for the treatment of ruptured anterior circulatory cerebral aneurysms at Hanoi Medical University Hospital.

Subjects and methods: A prospective cross-sectional descriptive study was conducted on 51 patients diagnosed with ruptured anterior circulatory cerebral aneurysms who underwent surgical intervention at the Department of Neurosurgery, Hanoi Medical University Hospital.

Results: Patient characteristics: The age group from 40–59 years old accounted for the highest proportion (51.0%). The proportion of females (54.9%) was higher than males (45.1%). Aneurysm characteristics: The majority of patients had only one aneurysm (76.5%). The average aneurysm neck diameter was 3.7 ± 1.1 mm (with 60.8% < 4 mm). The average aneurysm size was 6.5 ± 3.7 mm, with small aneurysms (< 7 mm) being the majority (64.7%) and saccular shape being predominant (84.3%). Intraoperative ICG fluorescence was applied in 20/51 patients (39.2%). ICG assessment immediately after the first clip placement showed that only 40.0% of cases achieved optimal results from the outset; residual aneurysm neck or saccular tissue was detected in 60.0%, afferent arteriole stenosis in 10.0%, and perforating branch occlusion in 5.0%. One month post-surgery, MSCT angiography of the cerebral vessels in 45 patients revealed a rate of afferent arteriole stenosis in the ICG-treated group of 10.0% (2/20), which tended to be lower than in the non-ICG-treated group of 13.3% (4/31).

Conclusion: Microsurgery combined with intraoperative ICG fluorescence assessment is a safe and effective method, playing a crucial role in assisting surgeons in making optimal clip placement decisions during surgery, helping to preserve the aneurysm and perforating branches.