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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 4. (a) Preoperative T2-weighted MR images showing intramedullary tumor formation at C6/7 accompanying extensive syrinx. (b) Preoperative contrast-enhanced T1-weighted MR images showing the enhanced tumor within the spinal cord. (c) Postoperative T2-weighted MR images showing complete resection of the tumor
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Figure 6: Patient 4. (a) Preoperative T2-weighted MR images showing intramedullary tumor formation at C6/7 accompanying extensive syrinx. (b) Preoperative contrast-enhanced T1-weighted MR images showing the enhanced tumor within the spinal cord. (c) Postoperative T2-weighted MR images showing complete resection of the tumor

Mentions: Patient 4: A 17-year-old male was admitted with moderate dysesthetic pain radiating from the posterior neck to the right upper extremity. Assessment of neurological condition before surgery suggested Grade 1 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted MRIs of the cervical spine showed an intramedullary tumor formation at C6/7 accompanying extensive syrinx [Figure 6a]. The tumor was enhanced on T1-weighted MRIs [Figure 6b]. Imaging diagnosis before surgery was intramedullary hemangioblastoma.


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 4. (a) Preoperative T2-weighted MR images showing intramedullary tumor formation at C6/7 accompanying extensive syrinx. (b) Preoperative contrast-enhanced T1-weighted MR images showing the enhanced tumor within the spinal cord. (c) Postoperative T2-weighted MR images showing complete resection of the tumor
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Patient 4. (a) Preoperative T2-weighted MR images showing intramedullary tumor formation at C6/7 accompanying extensive syrinx. (b) Preoperative contrast-enhanced T1-weighted MR images showing the enhanced tumor within the spinal cord. (c) Postoperative T2-weighted MR images showing complete resection of the tumor
Mentions: Patient 4: A 17-year-old male was admitted with moderate dysesthetic pain radiating from the posterior neck to the right upper extremity. Assessment of neurological condition before surgery suggested Grade 1 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted MRIs of the cervical spine showed an intramedullary tumor formation at C6/7 accompanying extensive syrinx [Figure 6a]. The tumor was enhanced on T1-weighted MRIs [Figure 6b]. Imaging diagnosis before surgery was intramedullary hemangioblastoma.

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