The use of indocyanine green videoangiography to optimize the dural opening for intracranial parasagittal lesions

Neurosurgery. 2012 Mar;70(1 Suppl Operative):61-3; discussion 63-4. doi: 10.1227/NEU.0b013e31822ecfeb.

Abstract

Background: We describe our clinical experience with the use of indocyanine green (ICG) videoangiography to delineate the locations of the cortical draining veins before dural opening in 3 cases of parasagittal lesions. With this technique, the veins are marked through the dura, and then the dura can be opened precisely to avoid cortical venous injury.

Objective: To demonstrate in a clinical series the adjunct use of intraoperative ICG angiography to optimize the dural opening for parasagittal lesions.

Methods: We describe 3 cases of parasagittal lesions, 2 meningiomas, and 1 arteriovenous malformation treated using the described technique.

Results: Once the dura had been exposed, ICG at a dose of 0.25 mg/kg was injected into the patient's peripheral vein as a bolus. When the dye reached the illuminated field of interest, ICG fluorescence was induced by the use of a light source with a wave-length ICG absorption band. Thereafter, the dural cortical veins were marked through the dura and precisely opened, avoiding cortical venous injury.

Conclusion: Indocyanine green video angiography is a safe, fast, inexpensive, and accurate investigation that allows the surgeon to strategically plan and protect important parasagittal dural venous drainage during craniotomy.

Publication types

  • Case Reports
  • Evaluation Study

MeSH terms

  • Aged
  • Cerebral Veins / surgery
  • Coloring Agents
  • Cranial Sinuses / surgery
  • Craniotomy / methods*
  • Dura Mater / surgery*
  • Female
  • Fluorescein Angiography / methods*
  • Humans
  • Indocyanine Green*
  • Intraoperative Complications / etiology
  • Intraoperative Complications / physiopathology
  • Intraoperative Complications / prevention & control
  • Male
  • Middle Aged
  • Neuronavigation / methods*
  • Video Recording / methods*

Substances

  • Coloring Agents
  • Indocyanine Green