Benefits and Limitations of Indocyanine Green Fluorescent Image-Guided Surgery for Spinal Intramedullary Tumors

Oper Neurosurg (Hagerstown). 2017 Dec 1;13(6):746-754. doi: 10.1093/ons/opx057.


Background: Intraoperative image guidance using near-infrared indocyanine green videoangiography (ICG-VA) has been used to provide real-time angiographic images during vascular or brain tumor surgery, and it is also being used for spine surgery.

Objective: To further investigate the benefits and limitations of ICG-VA image-guided surgery for spinal intramedullary tumors through retrospective study.

Methods: ICG-VA was used in 48 cases that were treated surgically over the past 5 yr. The pathological diagnoses of the tumors included astrocytic tumor, ependymal tumor, cavernous malformation, and hemangioblastoma.

Results: Localization of normal spinal arteries and veins on the dorsal surface of the spinal cord helped the surgeons determine the length or point of myelotomy. Well-demarcated tumor stain was recognized in limited cases of anaplastic or highly vascularized tumors, whereas the location of cavernous malformation was recognized as an avascular area on the dorsal surface of the spinal cord. Feeding arteries and tumor stain were well differentiated from draining veins in dorsal hemangioblastomas, but not in intramedullary deep-seated or ventral tumors. The preservation of small perforating branches of the anterior spinal artery after successful resection of the tumor could be well visualized.

Conclusion: ICG-VA can provide real-time information about vascular flow dynamics during the surgery of spinal intramedullary tumors, and it may help surgeons localize the normal circulation of the spinal cord, as well as the feeding arteries and draining veins, especially in highly vascular tumors. However, the benefits of intraoperative ICG-VA might be limited for intramedullary deep-seated or ventral tumors.

Keywords: Astrocytic tumor; Cavernous malformation; Ependymal tumor; Hemangioblastomas; Intraoperative image guidance; Near-infrared indocyanine green videoangiography; Spinal intramedullary tumor.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cerebral Angiography / methods
  • Female
  • Hemangioma, Cavernous, Central Nervous System / surgery
  • Humans
  • Indocyanine Green / metabolism*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Spinal Cord Neoplasms / diagnostic imaging*
  • Spinal Cord Neoplasms / surgery*
  • Surgery, Computer-Assisted / methods*
  • Young Adult


  • Indocyanine Green