Indocyanine green videoangiographyを活用したtarget bypassを併用してトラッピングし得た破裂遠位部中大脳動脈瘤の1例

Indocyanine Green Videoangiography-Guided Target Bypass for Surgical Trapping of Distal Middle Cerebral Artery Aneurysm:A Technical Case Report

Ⅰ．はじめに

　Indocyanine green（ICG）videoangiographyは簡便，低侵襲であり，かつ術中リアルタイムに脳血流の有無，方向を確認できることから，近年脳血管外科領域で頻用されるようになってきている．

　今回われわれは，ICG videoangiographyを有効に利用したtarget bypassを併用し，破裂遠位部中大脳動脈瘤を安全にトラッピングし得た症例を経験したので，文献的考察を加えて報告する．

　Intraoperative indocyanine green（ICG）videoangiography is simple, less invasive, and enables real-time observation of hemodynamics during neurovascular surgery. In this article, we describe a case of ruptured distal middle cerebral artery aneurysm, which was unclippable and required parent artery occlusion with extracranial-intracranial bypass. Under temporary clipping of the proximal vessel, ICG videoangiography demonstrated the proper target vessel for bypass through delayed and retrograde filling of the dye. In this operation, ICG videoangiography contributed to simpler and less invasive procedures, by avoiding dissection of the tight cerebral fissure and intraoperative angiography.