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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

Patient 3.(a) Preoperative T2-weighted MR images showing local enlargement and intramedullary mixed signal of the spinal cord at C6. (b) Preoperative T2*-weighted gradient-echo MR images showing mixed low signal within the spinal cord, suggesting the deposition of blood degradation products. (c) Postoperative T2-weighted MR images showing satisfactory recovery of intramedullary signal of the spinal cord
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Figure 4: Patient 3.(a) Preoperative T2-weighted MR images showing local enlargement and intramedullary mixed signal of the spinal cord at C6. (b) Preoperative T2*-weighted gradient-echo MR images showing mixed low signal within the spinal cord, suggesting the deposition of blood degradation products. (c) Postoperative T2-weighted MR images showing satisfactory recovery of intramedullary signal of the spinal cord

Mentions: Patient 3: A 42-year-old female was admitted with back pain, gait disturbance, and moderate dysesthesia of right upper extremity. Symptoms were more apparent in the upper extremities than in the lower extremities. Assessment of neurological condition before surgery suggested Grade 3 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted magnetic resonance images (MRIs) of the cervical spine showed local enlargement and intramedullary mixed signal of the spinal cord at C6 [Figure 4a]. T2*-weighted gradient-echo MRIs showed mixed low signal within the spinal cord [Figure 4b], which was consistent with blood degradation products. Imaging diagnosis before surgery was intramedullary hemorrhage associated with cavernous malformation.


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)

Patient 3.(a) Preoperative T2-weighted MR images showing local enlargement and intramedullary mixed signal of the spinal cord at C6. (b) Preoperative T2*-weighted gradient-echo MR images showing mixed low signal within the spinal cord, suggesting the deposition of blood degradation products. (c) Postoperative T2-weighted MR images showing satisfactory recovery of intramedullary signal of the spinal cord
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Patient 3.(a) Preoperative T2-weighted MR images showing local enlargement and intramedullary mixed signal of the spinal cord at C6. (b) Preoperative T2*-weighted gradient-echo MR images showing mixed low signal within the spinal cord, suggesting the deposition of blood degradation products. (c) Postoperative T2-weighted MR images showing satisfactory recovery of intramedullary signal of the spinal cord
Mentions: Patient 3: A 42-year-old female was admitted with back pain, gait disturbance, and moderate dysesthesia of right upper extremity. Symptoms were more apparent in the upper extremities than in the lower extremities. Assessment of neurological condition before surgery suggested Grade 3 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted magnetic resonance images (MRIs) of the cervical spine showed local enlargement and intramedullary mixed signal of the spinal cord at C6 [Figure 4a]. T2*-weighted gradient-echo MRIs showed mixed low signal within the spinal cord [Figure 4b], which was consistent with blood degradation products. Imaging diagnosis before surgery was intramedullary hemorrhage associated with cavernous malformation.

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