gms | German Medical Science

70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

12.05. - 15.05.2019, Würzburg

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

Meeting Abstract

  • presenting/speaker Gerrit Brinker - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Anna-Katharina Dempfle - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Catharina Schröter - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Sergej Telentschak - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Pantelis Stavrinou - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Lukas Görtz - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland
  • Roland Goldbrunner - Uniklinik Köln, Klinik für Allgemeine Neurochirurgie, Köln, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Skandinavischen Gesellschaft für Neurochirurgie. Würzburg, 12.-15.05.2019. Düsseldorf: German Medical Science GMS Publishing House; 2019. DocP009

doi: 10.3205/19dgnc347, urn:nbn:de:0183-19dgnc3474

Published: May 8, 2019

© 2019 Brinker et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.