Abstract
Background
The authors assessed the usefulness of intraoperative near-infrared indocyanine green videoangiography (ICG-VA) in the microscopic resection of hemangioblastomas.
Methods
From January 2009 to February 2012, nine consecutive patients (seven men, two women) who underwent surgery for hemangioblastomas using intraoperative ICG-VA were included in this study. Surgery was performed on four cystic cerebellar lesions with mural nodules, two solid tumors (one in the cerebellar hemisphere and one in the medulla oblongata), one spinal tumor and multiple tumors in two patients with von Hippel-Lindau disease. Of the nine patients, three were treated for recurrent tumor. The ICG-induced fluorescence images of hemangioblastomas with variable presentation were evaluated.
Results
All tumors could be completely removed en bloc. Blood flow in the tumor and tumor-related vessels at the brain surface were clearly detected by ICG-VA in all cases, except one recurrent tumor where postoperative adhesive scar tissue obstructed ICG-induced fluorescence resulting in poor delineation of the blood flow patterns and tumor margins. ICG-VA was also helpful for detecting the multiple small mural nodules within the cyst or the tumors buried under thin gliotic neural tissue despite reduced fluorescence.
Conclusion
Intraoperative ICG-VA is a safe and easy modality for confirming the vascular flow patterns in hemangioblastomas. In addition, ICG-VA provided useful information for intracystic small lesions or lesions concealed under thin brain tissue in order to accomplish total resection of these tumors.
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In this article, the authors assessed the use of intraoperative near-infrared indocyanine green videoangiography (ICG-VA) in the microsurgical resection of nine cases of hemangioblastoma. Although this information is not completely new, the study provides some insights in the use of ICG-VA in the treatment of hemangioblastomas presenting different surgical challenges. According to the authors’ experience, ICG-VA provided a valid contribution in most situations. This and other studies suggest that this technique has the potential to become the routine intraoperative vascular imaging during both cerebrovascular and tumour surgery. Nonetheless, it is worth mentioning the fact that the angiographic perspective provided by the ICG video technique is restricted to the field of view through the microscope. Furthermore, blood clots or, according to the authors’ experience, scar tissue may hide relevant vascular structures. So, as the ICG fluorescence may be affected by calcifications and thick-walled atherosclerotic vessels, therefore its use in combination with other methods—including visual inspection, intraoperative angiography and Doppler ultrasonography—should be evaluated in difficult cases.
Alfredo Conti
Messina, Italy
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Tamura, Y., Hirota, Y., Miyata, S. et al. The use of intraoperative near-infrared indocyanine green videoangiography in the microscopic resection of hemangioblastomas. Acta Neurochir 154, 1407–1412 (2012). https://doi.org/10.1007/s00701-012-1421-2
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DOI: https://doi.org/10.1007/s00701-012-1421-2