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Indocyanin Green Videoangiography Study of Hemangioblastomas

Published online by Cambridge University Press:  23 July 2018

Yasuo Murai ,
Koji Adachi ,
Fumihiro Matano ,
Kojiro Tateyama  and
Akira Teramoto
Yasuo Murai*
Affiliation:
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
Koji Adachi
Affiliation:
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
Fumihiro Matano
Affiliation:
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
Kojiro Tateyama
Affiliation:
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
Akira Teramoto
Affiliation:
Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
*
Department of Neurosurgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-86, Japan
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Abstract:

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Objective:

We present herein the intraoperative indocyanin green videoangiography (ICGVAG) findings for three cases of cerebellar hemangioblastoma (HB).

Cases:

Cerebellar HB was detected in three patients presenting with symptoms of vertigo and/or headaches and diagnosed on the basis of preoperative magnetic resonance imaging (MRI) and cerebral angiographic findings. Preoperative embolization of the tumor feeding artery was not performed in any of the patients. None of the patients underwent any procedure prior to ICGVAG that would affect the ICG findings, such as perilesional hemostatic coagulation or ablation. In each patient, it was possible to judge the approximate location of the tumor in relation to the brain surface and to distinguish the feeding and draining vessels. Following resection of the tumor, ICGVAG images confirmed that the mural nodule had been eliminated. None of the patients required blood transfusion, either during or after the surgery. For each patient, the lesion was pathologically confirmed as HB, postoperative contrast-enhanced MRI confirmed the absence of residual tumor, and diffusion-weighted MRI revealed no ischemic changes.

Results:

Differentiation of feeding and draining vessels in the region of the lesion is particularly important for successful surgical removal of HB. In the present three patients, ICGVAG findings enabled easy vascular differentiation and were also useful for confirming that there was no residual tumor. Indocyanin green videoangiography was concluded to be useful for safe resection of HB.

Résumé:

Résumé:Objectif:

Nous présentons les observations faites à la vidéoangiographie au vert d'indocyanine (VAVI) effectuée pendant la chirurgie chez trois cas d'hémangioblastomes (HB).

Observations cliniques:

Un HB a été découvert chez trois patients qui ont consulté pour vertige et/ou céphalée, chez qui le diagnostic a été posé par IRM et angiographic cérébrale avant la chirurgie. Ces patients n'ont pas subi d'embolisation de l'artère qui nourrissait la tumeur au cours de l'intervention ou de manœuvre pouvant influencer les observations à la VAVI avant cet examen, tels la coagulation hémostatique autour de la lésion ou l'ablation de la tumeur. Chez tous les patients, il a été possible d'évaluer le site approximatif de la tumeur en relation à la surface du cerveau et de distinguer les vaisseaux nourriciers des vaisseaux de drainage. Après la résection de la tumeur, les images de la VAVI effectuée pendant la chirurgie ont confirmé que le nodule mural avait été enlevé. Aucun des patients n'a eu besoin d'une transfusion sanguine pendant ou après la chirurgie. Le diagnostic d'HB a été confirmé en anatomopathologie chez tous les patients. L'IRM avec rehaussement de contraste après la chirurgie a confirmé l'absence de tumeur résiduelle et l'IRM pondérée en diffusion n'a pas montré de changements ischémiques.

Résultats:

La distinction entre les vaisseaux nourriciers et les vaisseaux de drainage dans la région de la lésion est particulièrement importante pour que la résection chirurgicale de l'HB soit un succès. Chez nos trois patients, les observations faites à la VAVI effectuée pendant la chirurgie ont permis de distinguer facilement le système vasculaire et ont également été utiles pour confirmer l'absence de tumeur résiduelle. Nous concluons que la VAVI est utile pour s'assurer que la résection d'un HB est effectuée sans danger.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 1 , January 2011 , pp. 41 - 47
Copyright
Copyright © Canadian Neurological Sciences Federation 2011

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