Application of intraoperative indocyanine green angiography for CNS tumors: results on the first 100 cases.
OBJECTIVE
To investigate the application of indocyanine green (ICG) videoangiography during microsurgery for central nervous system (CNS) tumors.


METHODS
One hundred patients with CNS tumors who underwent microsurgical resection from December 2006 to December 2008 were retrospectively analyzed. The diagnosis was high grade glioma in 54 cases, low grade in 17 cases, meningioma in 14 cases, metastasis in 12 cases and hemangioblastoma in 3 cases. Overall, ICG was injected intraoperatively 194 times. The standard dose of 25mg of dye was injected intravenously and intravascular fluorescence from within the blood vessels was imaged through an ad hoc microscope with dedicated software (Pentero, Carl Zeiss Co., Oberkochen, Germany). Pre-resection and post-resection arterial, capillary and venous ICG videoangiographic phases were intraoperatively observed and recorded.


RESULTS
ICG videangiography allowed for a good evaluation of blood flow in the tumoral and peritumoral exposed vessels in all cases. No side effects due to ICG were observed.


CONCLUSIONS
ICG video-angiography is a significant method for monitoring blood flow in the exposed vessels during microsurgical removal of CNS tumors. Pre-resection videoangiography provides useful information on the tumoral circulation and the pathology-induced alteration in surrounding brain circulation. Post-resection examination allows for an immediate check of patency of those vessels that are closely related to the tumor mass and that the surgeon does not want to damage.
Department of Neurosurgery, Fondazione Istituto Neurologico Carlo Besta, Via Celoria 11, 20133 Milano, Italy. ferrolipaolo@hotmail.com
P
P
Ferroli
F
F
Acerbi
E
E
Albanese
G
G
Tringali
M
M
Broggi
A
A
Franzini
G
G
Broggi
D016543:Central Nervous System Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D004396:Coloring Agents; D005451:Fluorescein Angiography / Q000379:methods*; D006801:Humans; D007208:Indocyanine Green; D016343:Monitoring, Intraoperative / Q000379:methods*; D011859:Radiography; D012189:Retrospective Studies; D014742:Videodisc Recording / Q000379:methods
D004396:Coloring Agents; D007208:Indocyanine Green