髄内腫瘍摘出における蛍光観察技術の現状と課題

Current Consensus and Challenges of Fluorescence Imaging Technology in the Surgery of Spinal Intramedullary Tumors

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・インドシアニングリーン蛍光血管造影（ICG-VA）は術中の定性的血流評価として有用であり，血管芽腫のような高血流の腫瘍では，流入動脈・流出静脈の区別に必須の技術である．

・ICG-VAは，腫瘍摘出後の脊髄実質の微細血流の評価にも活用できる．

・5-アミノレブリン酸による光線力学的診断は，髄内腫瘍の手術への応用が期待されるが，その有用性について検証すべき点も存在する．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2028年2月まで）。

　Surgery for spinal intramedullary tumors remains a major challenge for neurosurgeons. Successful surgery requires experience, skill, and intraoperative imaging support. Fluorescence imaging technology has become a valuable support in neurosurgical procedures of not only the brain but also the spinal cord. Indocyanine green videoangiography（IVG-VA）is becoming popular for the qualitative assessment of blood flow dynamics during spinal intramedullary tumor surgery. IVG-VA can provide real-time information and help surgeons localize the normal circulation of the spinal cord as well as the feeding arteries and draining veins, particularly in highly vascular tumors. It can also be used for the objective quantitative evaluation of microvascular blood flow in the spinal cord parenchyma after tumor removal. Photodynamic diagnosis using 5-aminolevulinic acid（PDD）is an essential intraoperative imaging guide for brain glioma surgery. PDD has gradually been used in spinal intramedullary tumor surgery. However, some aspects of its usefulness must be verified. This chapter focuses on the current consensus and challenges in fluorescence imaging technology for spinal intramedullary tumor surgery.