title: Use of microscope-integrated near-infrared indocyanine green videoangiography in the surgical treatment of intramedullary cavernous malformations: report of 8 cases.
abstract: OBJECTIVE
  The characteristics and efficacy of indocyanine green (ICG) videoangiography in cavernous malformation (CM) have not been fully elucidated. The purpose of this paper is to examine the potential utility of ICG videoangiography in the surgical treatment of intramedullary CMs.
  
  
  METHODS
  The authors conducted a retrospective review of 8 cases involving 5 men and 3 women who had undergone surgery for intramedullary CM between January 2008 and July 2011. All patients were evaluated by means of MRI. The MRI findings and clinical history in all cases suggested intramedullary CM as a preoperative diagnosis. In 2 of 8 cases, dilated venous structures associated with CMs were demonstrated. In one of these cases, there were coexisting extramedullary CMs. Intraoperatively, ICG fluorescence was observed for 5 minutes using microscope-integrated videoangiography.
  
  
  RESULTS
  In all 8 cases, intra- and extramedullary CMs were seen as avascular areas on ICG videoangiography. Indocyanine green videoangiography helped surgeons to localize and predict margins of the lesions before performing myelotomy. Importantly, in the cases with associated venous anomalies, ICG videoangiography was useful in delineating and preserving the venous structures. In extramedullary CMs located dorsal to the spinal cord, gradual ICG infiltration was seen, starting at 110 seconds and maximal at 210 seconds after injection. Postoperative MRI confirmed total removal of the lesions in all cases, and subsequent recovery of all patients was uneventful.
  
  
  CONCLUSIONS
  Indocyanine green videoangiography provided useful information with regard to the detection of lesion margins by demonstrating intramedullary CMs as avascular areas. In cases associated with venous anomalies, ICG contributed to safe and complete removal of the CMs by visualizing the venous structure. In extramedullary CMs, ICG videoangiography demonstrated the characteristic of slow blood flow within CMs.
authors.affiliation: Department of Neurosurgery, Graduate School of Medicine, Tohoku University, Sendai, Japan. endo@nsg.med.tohoku.ac.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.forename: Misaki
authors.initials: M
authors.lastname: Aizawa-Kohama
authors.forename: Kenichi
authors.initials: K
authors.lastname: Nagamatsu
authors.forename: Kensuke
authors.initials: K
authors.lastname: Murakami
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D005260:Female; D005451:Fluorescein Angiography; D020786:Hemangioma, Cavernous, Central Nervous System / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D019265:Spectroscopy, Near-Infrared; D013120:Spinal Cord Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery
chemical_list: D007208:Indocyanine Green