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Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography.

Takami T, Yamagata T, Naito K, Arima H, Ohata K - Surg Neurol Int (2013)

Bottom Line: There were no complications or side-effects related to ICG-VA.All angiographic images were well integrated into the microscopic view.Intraoperative vascular flow assessment using ICG-VA was easy, repeatable, and practical without any significant procedure-related risks.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

ABSTRACT

Background: The authors demonstrate the utility of indocyanine green videoangiography (ICG-VA) for intraoperative vascular flow assessment in the surgery of a variety of spinal intramedullary tumors to achieve an additional level of safety as well as precision with the surgical procedure.

Methods: Fourteen patients with spinal intramedullary tumors (nine cervical and five thoracic) operated on between August 2011 and April 2013 were included in the present study. A fluorescence surgical microscope was used to perform ICG-VA after standard exposure of the lesion to assess the dynamic flow of the spinal microvasculature.

Results: Twenty-seven ICG-VA injections were performed in 14 cases. Pathological diagnosis of the tumors included ependymoa, astrocytoma, cavernous malformation, or hemagioblastoma. There were no complications or side-effects related to ICG-VA. Intraoperative ICG-VA provided dynamic flow images of the spinal microvasculature in accordance with the progress of surgical procedures. Angiographic images could be divided into arterial, capillary, and venous phases. All angiographic images were well integrated into the microscopic view. The utility of ICG-VA could be summarized into three categories: (1) Localization of normal spinal arteries and veins, (2) assessment of posterior spinal venous circulation, and (3) differentiation of feeding arteries, tumor, and draining veins.

Conclusions: Intraoperative vascular flow assessment using ICG-VA was easy, repeatable, and practical without any significant procedure-related risks. ICG-VA can be used for careful analysis of spinal microvascular flow or anatomical orientation, which is necessary to ensure safe and precise resection of spinal intramedullary tumors.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photographs from Patient 4. (a) Photographs showing a slightly swollen spinal cord. (b) Photographs from the early phase of indocyanine green videoangiography (ICG-VA) showing the feeding arteries (arrows), tumor and draining veins (arrowheads). (c) Photographs showing a decrease in blood flow to the tumor after interruption of feeding arteries using small aneurysm clips. (d) Photographs showing the clear gliosis layer of tumor–cord interface after careful dissection of thick and cloudy pia mater that encircled the tumor. (e-f) ICG-VA images obtained after en bloc complete removal of the hemangioblastoma showing no sign of residual tumor and well preserved posterior spinal artery
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Figure 3: Intraoperative photographs from Patient 4. (a) Photographs showing a slightly swollen spinal cord. (b) Photographs from the early phase of indocyanine green videoangiography (ICG-VA) showing the feeding arteries (arrows), tumor and draining veins (arrowheads). (c) Photographs showing a decrease in blood flow to the tumor after interruption of feeding arteries using small aneurysm clips. (d) Photographs showing the clear gliosis layer of tumor–cord interface after careful dissection of thick and cloudy pia mater that encircled the tumor. (e-f) ICG-VA images obtained after en bloc complete removal of the hemangioblastoma showing no sign of residual tumor and well preserved posterior spinal artery

Mentions: In cases of a transpial approach to the tumor, such as for hemangioblastomas, feeding arteries were well differentiated from draining veins using ICG-VA [Figure 3b]. Feeding arteries were interrupted just proximal to the tumor itself, and a decrease in blood flow to the tumor was confirmed using ICG-VA [Figure 3c]. Thick and cloudy pia mater encircling the tumor was cut sharply to reveal the clear gliosis layer of tumor–cord interface. At the final stage of tumor resection, draining veins were coagulated and sharply cut. Complete resection of the tumor was performed under a microscope and confirmed using ICG-VA [Figure 3f].


Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography.

Takami T, Yamagata T, Naito K, Arima H, Ohata K - Surg Neurol Int (2013)

Intraoperative photographs from Patient 4. (a) Photographs showing a slightly swollen spinal cord. (b) Photographs from the early phase of indocyanine green videoangiography (ICG-VA) showing the feeding arteries (arrows), tumor and draining veins (arrowheads). (c) Photographs showing a decrease in blood flow to the tumor after interruption of feeding arteries using small aneurysm clips. (d) Photographs showing the clear gliosis layer of tumor–cord interface after careful dissection of thick and cloudy pia mater that encircled the tumor. (e-f) ICG-VA images obtained after en bloc complete removal of the hemangioblastoma showing no sign of residual tumor and well preserved posterior spinal artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815013&req=5

Figure 3: Intraoperative photographs from Patient 4. (a) Photographs showing a slightly swollen spinal cord. (b) Photographs from the early phase of indocyanine green videoangiography (ICG-VA) showing the feeding arteries (arrows), tumor and draining veins (arrowheads). (c) Photographs showing a decrease in blood flow to the tumor after interruption of feeding arteries using small aneurysm clips. (d) Photographs showing the clear gliosis layer of tumor–cord interface after careful dissection of thick and cloudy pia mater that encircled the tumor. (e-f) ICG-VA images obtained after en bloc complete removal of the hemangioblastoma showing no sign of residual tumor and well preserved posterior spinal artery
Mentions: In cases of a transpial approach to the tumor, such as for hemangioblastomas, feeding arteries were well differentiated from draining veins using ICG-VA [Figure 3b]. Feeding arteries were interrupted just proximal to the tumor itself, and a decrease in blood flow to the tumor was confirmed using ICG-VA [Figure 3c]. Thick and cloudy pia mater encircling the tumor was cut sharply to reveal the clear gliosis layer of tumor–cord interface. At the final stage of tumor resection, draining veins were coagulated and sharply cut. Complete resection of the tumor was performed under a microscope and confirmed using ICG-VA [Figure 3f].

Bottom Line: There were no complications or side-effects related to ICG-VA.All angiographic images were well integrated into the microscopic view.Intraoperative vascular flow assessment using ICG-VA was easy, repeatable, and practical without any significant procedure-related risks.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.

ABSTRACT

Background: The authors demonstrate the utility of indocyanine green videoangiography (ICG-VA) for intraoperative vascular flow assessment in the surgery of a variety of spinal intramedullary tumors to achieve an additional level of safety as well as precision with the surgical procedure.

Methods: Fourteen patients with spinal intramedullary tumors (nine cervical and five thoracic) operated on between August 2011 and April 2013 were included in the present study. A fluorescence surgical microscope was used to perform ICG-VA after standard exposure of the lesion to assess the dynamic flow of the spinal microvasculature.

Results: Twenty-seven ICG-VA injections were performed in 14 cases. Pathological diagnosis of the tumors included ependymoa, astrocytoma, cavernous malformation, or hemagioblastoma. There were no complications or side-effects related to ICG-VA. Intraoperative ICG-VA provided dynamic flow images of the spinal microvasculature in accordance with the progress of surgical procedures. Angiographic images could be divided into arterial, capillary, and venous phases. All angiographic images were well integrated into the microscopic view. The utility of ICG-VA could be summarized into three categories: (1) Localization of normal spinal arteries and veins, (2) assessment of posterior spinal venous circulation, and (3) differentiation of feeding arteries, tumor, and draining veins.

Conclusions: Intraoperative vascular flow assessment using ICG-VA was easy, repeatable, and practical without any significant procedure-related risks. ICG-VA can be used for careful analysis of spinal microvascular flow or anatomical orientation, which is necessary to ensure safe and precise resection of spinal intramedullary tumors.

No MeSH data available.


Related in: MedlinePlus