Preliminary personal experiences with the application of near-infrared indocyanine green videoangiography in extracranial vertebral artery surgery.
BACKGROUND
We evaluated the feasibility, usefulness, and limitations of near-infrared indocyanine green (ICG) videoangiography during procedures involving the extracranial vertebral artery (VA).


METHODS
Nine patients (2 women, 7 men; mean age, 55 years) were evaluated at 2 neurosurgical centers. Near-infrared ICG videoangiography was applied during transposition and rerouting of the first segment of VA (V1; n = 6) and during resection of neurinomas near the second (V2; n = 1) and third (V3; n = 2) segments of VA.


RESULTS
Early after ICG injection, V1 fluoresced homogenously. The fluorescence of V2 and V3 varied. Without extrinsic compression, these segments appeared as noncontiguous hot spots because the VA runs freely in a periosteal sheath surrounded by a venous plexus that attenuates the fluorescent light. Hot spots corresponded to areas where the artery neared the surface. With extrinsic compression, VA enhanced homogenously because it was pushed against the periosteal layer. During the late phase, the V1 signal was attenuated, whereas the venous plexus surrounding V2 and V3 enhanced homogeneously, thereby masking the VA itself. Near-infrared ICG videoangiography helped to confirm VA patency during transposition and rerouting but was not helpful during VA exposure because the periosteal sheath must already be exposed to detect the VA or its surrounding plexus. After exposure, videoangiography can help to determine the position of the VA within its periosteal sheath.


CONCLUSIONS
Videoangiography can be used to provide information about the patency of the VA and its location within the periosteal sheath to prevent injury during resection of tumor adherent to the periosteal sheath.
Bruneau
Michaël
M
Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. mbruneau@ulb.ac.be
Sauvageau
Eric
E
Nakaji
Peter
P
Vandesteene
Arlette
A
Lubicz
Boris
B
Chang
Steve W
SW
Balériaux
Danielle
D
Brotchi
Jacques
J
De Witte
Olivier
O
Spetzler
Robert F
RF
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared / Q000379:methods*; D014711:Vertebral Artery / Q000601:surgery*; D020217:Vertebral Artery Dissection / Q000601:surgery*; D014742:Videodisc Recording / Q000379:methods
D007208:Indocyanine Green