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Intraoperative indocyanine green (ICG) videoangiography in haemangioblastoma surgery
Intraoperative Indocyaningrün (ICG)-Videoangiografie in der Hämangioblastomchirurgie
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Veröffentlicht: | 4. Juni 2021 |
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Objective: Hemangioblastomas are highly vascularized tumors and can cause an extensive architecture of surrounding pathological vessels. During microsurgical en-bloc tumor resection, it is crucial to first ligate tumor-feeding vessels. However, the distinction between these tumor-feeding vessels and draining veins is usually not obvious even under microscopic view. Indocyanine green (ICG) videoangiography is an intraoperative procedure that enables time-resolved fluorescence-based imaging of vessels (Figure 1 [Fig. 1]). The aim of this investigation is to provide recommendations in which hemangioblastoma cases this technique might be beneficial for safe en-bloc tumor resection.
Methods: We reviewed all resected CNS hemangioblastomas over a period of 28 months (Aug 2018 - Nov 2020) in our VHL center to identify surgeries in which ICG angiography was used. Analyzing these cases, we qualitatively evaluated the benefit of intraoperative ICG angiography to identify possible tumor-feeding vessels and draining veins. Identified advantages and limitations of this technique were collected.
Results: In total, 48 patients had surgery for removal of up to six hemangioblastomas. Intraoperative ICG videoangiography was performed for 13 spinal and two intracranial hemangioblastoma in 15 surgeries (31 %). In 13 of the selected cases, the applied intraoperative ICG videoangiography provided useful information about the vascularization of the tumor and was therefore considered helpful (Figure 1 [Fig. 1]). In two cases, the pathological vessels could not be clearly defined as tumor-feeding or draining vessels. Complete tumor removal was achieved in all patients. One patient experienced facial nerve palsy (House-Brackmann grade III) after removal of a tumor at the cerebellopontine angle.
Conclusion: ICG videoangiography offers real-time intraoperative imaging of the tumor vasculature and thus improves surgical decision-making. It should be noted that ICG videoangiography requires direct microscopic visualization of the structures to be assessed. For structures that are located deeper in or covered by the parenchyma, the information gain from ICG videoangiography is clearly limited.