Technique and Expected Benefit of Intraoperative Perfusion Imaging of Peripheral Nerves.

IF 1.5 Q3 SURGERY
Plastic and Reconstructive Surgery Global Open Pub Date : 2024-11-05 eCollection Date: 2024-11-01 DOI:10.1097/GOX.0000000000006281
Benedikt Schäfer, Gerrit Freund, Jonah Orr, Kay Nolte, Joachim Weis, Jörg Bahm, Justus P Beier
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Abstract

Peripheral nerve surgery, particularly in cases of nerve compression syndrome (NCS), necessitates a comprehensive evaluation of intraneural blood flow, as localized reductions in nerve perfusion are integral to the etiopathogenesis of such conditions. Although nerve perfusion is currently guided by morphologic characteristics, this assessment is subjective and prone to bias. Intraoperative fluorescence-assisted perfusion imaging with indocyanine green (ICG) is an established tool in flap and lymphatic surgery to objectively assess perfusion intraoperatively. However, only a few unspecific applications of ICG in peripheral nerve surgery have been published so far. In this study, we performed intraoperative perfusion imaging using ICG in 16 consecutive operations within the peripheral nervous system, including microsurgical reconstructions after obstetric brachial plexus injury, decompression for NCS, and vascularized ulnar nerve interposition transfers. Our findings show the utility of ICG in delineating healthy perfusion borders at proximal and distal stump levels after neuroma resection, and we demonstrate a correlation between histological findings and these clinically observed perfusion patterns. In NCS cases, we demonstrate that ICG imaging is effective in highlighting reduced perfusion predecompression and improved perfusion postdecompression. Additionally, ICG proved valuable for assessing perfusion of free vascularized nerve grafts. Intraoperative ICG perfusion imaging is a valuable tool during surgery of the peripheral nervous system, providing insights into the etiopathogenesis of NCS and aiding in the visualization of perfusion. This study underscores the potential of ICG in nerve surgery and its applicability for improving surgical outcomes and advancing our understanding of peripheral nerve pathologies.

外周神经术中灌注成像的技术和预期收益。
周围神经手术,尤其是神经压迫综合征(NCS)病例,需要对神经内血流进行全面评估,因为局部神经灌注减少是此类病症的发病机制之一。尽管目前神经灌注是以形态学特征为指导,但这种评估是主观的,容易出现偏差。使用吲哚菁绿(ICG)进行术中荧光辅助灌注成像是皮瓣和淋巴手术中一种成熟的工具,用于客观评估术中灌注情况。然而,迄今为止,仅有少数几篇关于 ICG 在周围神经手术中的非特异性应用的文章发表。在这项研究中,我们在 16 例连续的周围神经系统手术中使用 ICG 进行了术中灌注成像,包括产科臂丛神经损伤后的显微外科重建、NCS 的减压以及血管化尺神经间置转移。我们的研究结果表明,在神经瘤切除术后,ICG 可用于划定近端和远端残端水平的健康灌注边界,我们还证明了组织学发现与这些临床观察到的灌注模式之间的相关性。在 NCS 病例中,我们证明 ICG 成像能有效显示减压前灌注减少和减压后灌注改善的情况。此外,ICG 对评估游离血管神经移植物的灌注情况也很有价值。术中 ICG 灌注成像是外周神经系统手术中的一项重要工具,它能帮助了解 NCS 的发病机制并帮助观察灌注情况。这项研究强调了 ICG 在神经手术中的潜力,以及它在改善手术效果和增进我们对周围神经病理的了解方面的适用性。
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来源期刊
CiteScore
2.20
自引率
13.30%
发文量
1584
审稿时长
10 weeks
期刊介绍: Plastic and Reconstructive Surgery—Global Open is an open access, peer reviewed, international journal focusing on global plastic and reconstructive surgery.Plastic and Reconstructive Surgery—Global Open publishes on all areas of plastic and reconstructive surgery, including basic science/experimental studies pertinent to the field and also clinical articles on such topics as: breast reconstruction, head and neck surgery, pediatric and craniofacial surgery, hand and microsurgery, wound healing, and cosmetic and aesthetic surgery. Clinical studies, experimental articles, ideas and innovations, and techniques and case reports are all welcome article types. Manuscript submission is open to all surgeons, researchers, and other health care providers world-wide who wish to communicate their research results on topics related to plastic and reconstructive surgery. Furthermore, Plastic and Reconstructive Surgery—Global Open, a complimentary journal to Plastic and Reconstructive Surgery, provides an open access venue for the publication of those research studies sponsored by private and public funding agencies that require open access publication of study results. Its mission is to disseminate high quality, peer reviewed research in plastic and reconstructive surgery to the widest possible global audience, through an open access platform. As an open access journal, Plastic and Reconstructive Surgery—Global Open offers its content for free to any viewer. Authors of articles retain their copyright to the materials published. Additionally, Plastic and Reconstructive Surgery—Global Open provides rapid review and publication of accepted papers.
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