title: ICG videography facilitates interpretation of vascular supply and anatomical landmarks in intramedullary spinal lesions: two case reports.
abstract: METHODS
  This is an illustration of two case reports.
  
  
  OBJECTIVE
  We present two cases where intradural indocyanine-green (ICG) videography facilitated interpretation of vascular supply patterns and anatomic landmarks in intramedullary spinal lesions.
  
  
  BACKGROUND
  ICG videography is a new, complimentary imaging method, that is routinely employed in the context of vascular neurosurgical procedures and has recently been described to facilitate localization of intradural spinal lesions before dural opening. Its role in the setting of intramedullary lesions is less well defined.
  
  
  METHODS
  Two cases are presented. The first patient (case 1) had a small, diffuse, intramedullary lesion of unknown etiology who was referred for additional work-up and surgery. The second patient had presented with progressive paraparesis and ataxia due to an extensive intradural lesion, and he was referred for resection of the tumor.Routine exposure of the spinal cord via (hemi-)laminectomy and durotomy was followed by ICG videography (injection of intravenous indocyanine green, visualization with operating microscope in combination with an additional fluorescent light source) to guide the surgical strategy.
  
  
  RESULTS
  In case 1, ICG videography helped to delineate the anatomic midline for optimization of myelotomy. In case 2, imaging was able to identify arterial feeders of the highly vascularized lesion and simplified safe removal of the lesion.
  
  
  CONCLUSIONS
  ICG videography may represent a useful adjunct for optimization of surgical approach and strategy in intramedullary spinal tumors in selected cases. The anatomic midline can be safely identified in cases where usual landmarks are distorted, and better interpretation of supply patterns in highly vascularized lesions may increase safety of resection.
authors.affiliation: Department of Neurosurgery, University Hospital Innsbruck, Austria. gerrit.schubert@gmx.net
authors.forename: Gerrit Alexander
authors.initials: GA
authors.lastname: Schubert
authors.forename: Kirsten
authors.initials: K
authors.lastname: Schmieder
authors.forename: Marcel
authors.initials: M
authors.lastname: Seiz-Rosenhagen
authors.forename: Claudius
authors.initials: C
authors.lastname: Thomé
mesh_terms: D000792:Angiography / Q000379:methods; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D013116:Spinal Cord / Q000033:anatomy & histology / Q000098:blood supply* / Q000000981:diagnostic imaging*; D013120:Spinal Cord Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D014741:Video Recording / Q000379:methods*; D055815:Young Adult
chemical_list: D007208:Indocyanine Green