The Use of Indocyanine Green Videoangiography to Optimize the Dural Opening for Intracranial Parasagittal Lesions

Abstract

We describe our clinical experience with the use of indocyanine green (ICG) videoangiography to delineate the locations of the cortical draining veins before dural opening in 3 cases of parasagittal lesions. With this technique, the veins are marked through the dura, and then the dura can be opened precisely to avoid cortical venous injury. To demonstrate in a clinical series the adjunct use of intraoperative ICG angiography to optimize the dural opening for parasagittal lesions. We describe 3 cases of parasagittal lesions, 2 meningiomas, and 1 arteriovenous malformation treated using the described technique. Once the dura had been exposed, ICG at a dose of 0.25 mg/kg was injected into the patient's peripheral vein as a bolus. When the dye reached the illuminated field of interest, ICG fluorescence was induced by the use of a light source with a wave-length ICG absorption band. Thereafter, the dural cortical veins were marked through the dura and precisely opened, avoiding cortical venous injury. Indocyanine green video angiography is a safe, fast, inexpensive, and accurate investigation that allows the surgeon to strategically plan and protect important parasagittal dural venous drainage during craniotomy.