Article
ICG videoangiography is useful during surgical excision of spinal intramedullary haemangioblastoma – a report of three cases
Die ICG-Videoangiographie ist hilfreich bei der Exstirpation von spinalen intramedullären Hämangioblastomen – drei Fallberichte
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Published: | May 8, 2019 |
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Objective: Hemangioblastomas are benign tumorous lesions that, although rarely, can occur in the spinal chord. As they are highly vascularized, surgical excision should take into account knowledge of the specific arterial supply and venous draining system. We applied indocyanine green videoangiography (ICG-VA) during surgery of intramedullary hemangioblastomas in order to clarify these vascular flow patterns.
Methods: In three patients with spinal, intramedullary hemangioblastomas intraoperative indocyanine green videoangiography (ICG-VA) was performed prior to and after microsurgical excision. Time course of fluorescence was evaluated qualitatively by inspection of the video and quantitatively by the Flow800-module in vascular regions of interest.
Results: In all three patients, feeding arteries, nidus and draining veins could be identified and distinguished from each other (see Figure 1 [Fig. 1]). Moreover, early draining veins were detected in all cases. Quantitative analysis by Flow800-module showed arteriovenous transit times of 0.9-1.4s in early veins, and 2.9-4.9s in late veins. Surgical strategy was adjusted according to the findings of ICG-VA. After resection, nidal fluorescence uptake disappeared, which correlated with complete resection shown by MRI later on.
Conclusion: In intramedullary hemangioblastomas, ICG-VA intraoperatively distinguishes feeding arteries and draining arterialized veins and can help in finding the appropriate surgical strategy. Early draining veins may play a role in venous congestion and contribute to longitudinal chord edema in the presence of spinal hemangioblastomas.