The Use of Indocyanine Green Videography for Intraoperative Localization of Intradural Spinal Tumors

Abstract

Prospective. To characterize the role of indocyanine-green videography in the intraoperative localization of intradural spinal tumors. Correct intraoperative localization of intradural spinal tumors as well as tailored dural opening is essential in surgery and can be demanding in some instances. We investigated the role of indocyanine green (ICG) videography to correctly localize intradural, spinal tumors. We report a series of 30 patients with intradural spinal tumors, in which (hemi-)laminectomy or extended laminotomy was followed by ICG videography to determine intradural tumor margins (injection of intravenous ICG, visualization with operating microscope in combination with an additional, fluorescent light source). Tumor projection was verified after dural opening, and surgical resection was continued thereafter. Imaging was conducted without complications in all cases. Identification of the tumor margins before dural opening was achieved in 28 cases (93%), either by tumor enhancement or absence of ICG uptake in relation to the surrounding spinal cord or nerve roots. In 1 case, ICG videography helped to correct the previously determined level of exposure and led to cranial extension of the bony exposure. No significant contrast enhancement was seen in 2 patients who demonstrated a small lesion ventrolaterally to the cervical spinal cord. ICG videography represents a helpful tool to localize the position of intraspinal, intradural tumors, which are lateral or dorsal to the spinal cord or nerve roots. Bony exposure can be optimized before dural incision. Positioning and length of dural incision may be tailored to reduce the incidence of complications such as leakage of cerebrospinal fluid and/or accidental fiber damage.