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Application of intraoperative indocyanine green videoangiography to brain tumor surgery

  • Clinical Article
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Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Videoangiography using indocyanine green (ICG) has been used in the ophthalmologic field for a long time. It was introduced to the neurosurgical field several years ago but has been limited to vascular surgeries. We applied ICG videoangiography to brain tumor surgery and evaluated the usefulness.

Methods

Twenty-three patients with a brain tumor who underwent microsurgical resection were analyzed. The pathological diagnosis was meningioma in 15 patients, metastasis in three, glioma in three, and hemangioblastoma in two. A microscope with a special filter and infrared excitation light to illuminate the operating field was used in this study. The intravascular fluorescence was imaged with a video camera attached to the microscope. ICG was injected intravenously with the dose of 5–25 mg, and overall, ICG was injected intraoperatively 32 times.

Results

ICG videoangiography allowed for an excellent evaluation of blood flow in the tumoral and peri-tumoral vessels both before and after the resection in all cases.

Conclusions

ICG videoangiography is a useful method for monitoring blood flow in the exposed vessels during microsurgery for a brain tumor. This noninvasive method is simple, safe, cost-effective, and easily repeatable. Before resection, it provides information on the tumoral and peri-tumoral circulation including sequential visualization of vessels or direction of the blood flow. After resection, it checks the patency of the peri-tumoral vessels and is especially useful for the vein. This ICG videoangiography can be an alternative tool to intraoperative angiography or Doppler ultrasonography in selective cases.

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Acknowledgments

This work was supported by the Mid-career Researcher Program through a National Research Foundation grant funded by the Korean Ministry of Education, Science, and Technology (No. R01-2008-000-20545-0), and a faculty research grant of Yonsei University College of Medicine for 2008 (6-2008-0174) to Jong Hee Chang.

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Neuro-Oncology Clinic and Brain Research Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemoon-gu, Seoul, 120–752, Korea (R.O.K.)

    Eui Hyun Kim, Jin Mo Cho, Jong Hee Chang, Sun Ho Kim & Kyu Sung Lee

Authors
  1. Eui Hyun Kim
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  2. Jin Mo Cho
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  3. Jong Hee Chang
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  4. Sun Ho Kim
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Corresponding author

Correspondence to Jong Hee Chang.

Additional information

Comment

The authors present their experience on brain tumor surgery assisted by the intra-operative use of indocyanine green videoangiography (ICG). In this series, ICG emerges as a simple, inexpensive, rapid, non-invasive, and reliable implementation for vascular management in the neuro-oncological setting. The authors report advantages and limits of the technique by means of an effectively illustrated surgical series. For educational purposes, we can synthesize that ICG might be functional to selected surgical scenarios. For example, when the tumor is located close to major vessels that could be potentially injured by surgery (i.e., Sylvian fissure tumors), when approaching high vascularized tumors (i.e., hemangioblastomas or some meningiomas), or when the direction of the blood flow of peri-tumoral vasculature must be recognized in a pre-resection stage in order to plan a correct removal strategy (i.e., cortical veins in parasagittal meningioma surgery).

We agree with the authors that brain tumor surgery can, in selected cases, take advantage of the intra-operative use of ICG. Further studies on a large series of patients are needed to define the real clinical impact of ICG on a patient’s outcome.

Domenico d’Avella

Alessandro Della Puppa

Padova, Italy

Comment

Intraoperative indocyanine green (ICG) angiography is an established method to support the microsurgical therapy of intracranial aneurysms and AVMs. The authors performed ICG angios during the removal of 15 meningiomas, three metastases, three gliomas, and two hemangioblastomas, which allowed them to make several useful findings at different phases of surgeries, including:

* localization of the sinus and cortical veins before opening the dura.

* visualization of feeding arteries, draining veins, and mass of a hemangioblastoma before opening the dura.

* relationship between an insular anaplastic astrocytoma and branches of the MCA.

* cortical vein patency in the tumor bed after removal of a meningioma.

* a vein thought to be open was not and could be sacrificed for a total removal.

The authors are to be congratulated for a timely addition to the growing list of instances during CNS tumor surgery in which ICG angio may reveal important aspects.

Juha E Jääskeläinen

Kuopio, Finland

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Kim, E.H., Cho, J.M., Chang, J.H. et al. Application of intraoperative indocyanine green videoangiography to brain tumor surgery. Acta Neurochir 153, 1487–1495 (2011). https://doi.org/10.1007/s00701-011-1046-x

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  • DOI: https://doi.org/10.1007/s00701-011-1046-x

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