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

Nussbaum, Eric S. MD; Defillo, Archie MD; Nussbaum, Leslie MD, PhD

doi: 10.1227/NEU.0b013e31822ecfeb
Instrumentation Assessment

BACKGROUND: 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.

OBJECTIVE: To demonstrate in a clinical series the adjunct use of intraoperative ICG angiography to optimize the dural opening for parasagittal lesions.

METHODS: We describe 3 cases of parasagittal lesions, 2 meningiomas, and 1 arteriovenous malformation treated using the described technique.

RESULTS: 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.

CONCLUSION: 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.

National Brain Aneurysm Center, St. Joseph's Hospital, St. Paul, Minnesota

Correspondence: Eric S. Nussbaum, MD, 3033 Excelsior Blvd, Ste 403, Minneapolis, MN 55416. E-mail: LNUSSBAUM@comcast.net

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Received February 3, 2011

Accepted May 11, 2011

Copyright © by the Congress of Neurological Surgeons