title: Identification of venous sinus, tumor location, and pial supply during meningioma surgery by transdural indocyanine green videography.
abstract: OBJECTIVE
  Indocyanine green (ICG) videography is commonly used in the neurosurgical field for minimally invasive neurosurgery. The aim of this study was to evaluate a new intraoperative imaging modality by performing transdural ICG videography during surgery for meningiomas.
  
  
  METHODS
  Between March 2011 and April 2012, 10 patients with meningiomas received intravenous injection of 12.5 mg ICG just prior to dural opening. The cases comprised 8 convexity meningiomas and 2 foramen magnum meningiomas. Efficacy of the transdural ICG videography was assessed in terms of the tumor volume, the circulation time from the first appearance of the vessel to the appearance of the venous sinus, the tendency to bleed, and the discrimination of the venous sinus.
  
  
  RESULTS
  The mean tumor volume was 71.6 ± 87.9 ml (the mean is expressed ± SD throughout). The cortical arteries, veins, and the venous sinus were identified by the ICG videography transdurally. The projection of the meningiomas was identified by a shadow (which the authors call the eclipse sign). Total eclipse signs were obtained in 8 cases and partial eclipse signs were obtained in 2 cases; tumor volume in the latter was more than 200 ml. In 5 of 10 cases the adjacent venous sinuses were exposed and were successfully visualized by ICG videography in 5.92 ± 1.05 seconds from the first appearance of the vessel. In 5 of 10 cases the total and the partial eclipse signs were diminished in 3.46 ± 1.31 seconds. The diminishment of the total and the partial eclipse sign was earlier than the visualization of the venous sinus (p = 0.011, t-test), revealing bleeding from the tumor that was observed until coagulation of the feeding arteries from the intracranial arteries.
  
  
  CONCLUSIONS
  Prior to opening of the dura mater, transdural ICG videography was used successfully to visualize the dural attachment of meningiomas and the venous sinus, resulting in safe and appropriate dural opening. The diminishment of the total and partial eclipse signs may represent significant feeding from the intracranial arteries and a tendency to bleed during resection.
authors: Department of Neurosurgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. eba@fukuoka-u.ac.jp
authors: Tetsuya
authors: T
authors: Ueba
authors: Masakazu
authors: M
authors: Okawa
authors: Hiroshi
authors: H
authors: Abe
authors: Masani
authors: M
authors: Nonaka
authors: Mitsutoshi
authors: M
authors: Iwaasa
authors: Toshio
authors: T
authors: Higashi
authors: Tooru
authors: T
authors: Inoue
authors: Koichi
authors: K
authors: Takano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000209:etiology; D004396:Coloring Agents; D003287:Contrast Media; D003392:Cranial Sinuses; D004388:Dura Mater; D005260:Female; D005682:Gadolinium; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D014741:Video Recording / Q000379:methods*
chemical_list: D004396:Coloring Agents; D003287:Contrast Media; D005682:Gadolinium; D007208:Indocyanine Green