Intraoperative Use of Indocyanine Green Fluorescence Videography for Resection of a Spinal Cord Hemangioblastoma

Abstract

Indocyanine green (ICG) fluorescence videography has been recently applied to the neurosurgical field, mostly in the management of cerebral aneurysms, but has had limited description in the subspecialty of spine or oncological neurosurgery. We describe a novel application of this previously defined surgical tool to assist in the resection of a residual spinal cord hemangioblastoma. Our patient is a 49-year-old woman with a residual symptomatic cervical hemangioblastoma that was previously embolized and resected at another institution. After initial symptomatic improvement, she returned with progressive symptoms, increasing radiographic spinal cord edema, and a residual lesion at the level of C1. We resected the remaining tumor with the adjuvant use of ICG fluorescence videography. Intraoperative injection of ICG clearly identified a component of the tumor underlying adhesive, opaque arachnoid that was not visualized by direct microscopy. Immediate postresection ICG videography suggested a complete resection was achieved which was later corroborated by postoperative magnetic resonance imaging. The adjuvant use of ICG videography is a useful surgical tool that permits greater visualization of the complete extent of the lesion, particularly in managing recurrent or residual lesions obscured by adhesions.