Neurological Surgery 脳神経外科43巻7号

2015年07月発行

総説

Indocyanine Green Videoangiographyの臨床応用—現状と展望

著者： 嵯峨健広¹ 鎌田恭輔¹

所属機関： ¹旭川医科大学脳神経外科

ページ範囲：P.593 - P.601

Ⅰ．はじめに
　脳神経外科手術において術中の脳動静脈損傷・閉塞は組織還流障害による脳梗塞，術後脳浮腫などの合併症に直結する重要な因子であり，これをいかにして安全にかつ正確に回避するかということは重要な命題である．インドシアニングリーン（indocyanine green：ICG）を用いた蛍光血管撮影（ICG videoangiography：ICG-VA）は術中real timeに血管・血流を評価する方法として用いられるようになり，脳動脈瘤，脳動静脈奇形（cerebral arteriovenous malformation：AVM），バイパス手術などの脳血管手術を中心として有用性が報告されており，その簡便性や安全性・有用性により脳神経外科領域において広く受け入れられている．また，近年はICG-VAで得られた時系列・濃度変化信号解析による輝度変化と血流変化の関係についての報告も散見されており，その有用性はさらに広がることが期待されている．一方で，汎用性の高い方法ではあるが，使用頻度が増えるにつれて，ICG-VAの使用方法が不適切な例や，撮影データの評価が不十分なまま放置される例に遭遇することも多くなった．機能予後のために使用しているICG-VAに関して，routineな使用のみならず，その原理，限界を知ったうえで本法を臨床応用診断機器として使用していくことが重要である．
　本稿ではICG-VAの原理および臨床応用とその留意点，今後の課題について紹介する．

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