Efficacy of Intra-arterial Indocyanine Green Videoangiography in Hemangioblastoma Surgery: A Case Report

Abstract

Intravenous indocyanine green (ICG) videoangiography is reportedly useful for vascular neurosurgery, and for treating hemangioblastoma due to its high vascularity. Videoangiography obtained after intra-arterial ICG injection has emerged as a more useful option than that after intravenous injection. This report offers the first description of a case of hemangioblastoma successfully treated using intra-arterial ICG videoangiography, and describes the efficacy of this technique. A 20-year-old man presented with progressive cerebellar ataxia and dysphagia. Magnetic resonance imaging (MRI) revealed an enhanced solid tumor in the medulla oblongata. Digital subtraction angiography (DSA) showed a highly vascularized tumor. Surgery was performed to remove the tumor in a hybrid operating room. A catheter was introduced into the vertebral artery (VA) for intra-arterial ICG videoangiography. Superficial feeders and drainers were identified and flow dynamic changes in the tumor were assessed by intra-arterial ICG videoangiography. The tumor was removed after confirming lack of flow in the drainer. Intra-arterial ICG videoangiography was more useful than intravenous ICG videoangiography in hemangioblastoma surgery for identifying feeders and drainers and assessing flow dynamics in the tumor. Use of Flow 800 made these findings simpler and easier to evaluate.

Evaluation of Serial Intra-Arterial Indocyanine Green Videoangiography in the Surgical Treatment of Cranial and Craniocervical Junction Arteriovenous Fistulae: A Case Series

“…Third, IA-ICG videoangiography allows specific identification of target vessels into which the injection catheter is advanced (such as the segmental artery or external carotid artery). 10 Fourth, IA-ICG videoangiography requires only a small amount of ICG (0.01-0.1 mg/mL) 11,12,23,24 compared with IV-ICG (1.0-10.0 mg/ mL). [1][2][3][4]6,9 Although ICG has been used in various medical fields with a high level of safety, it also causes adverse reactions, including severe (such as hypotension and bradycardia; incidence, 0.05%) and moderate reactions (such as nausea and pruritus; incidence, 0.2%).…”

Efficacy of intraarterial indocyanine green videoangiography in surgery for arteriovenous fistula at the craniocervical junction in a hybrid operating room: illustrative cases

“…We have not encountered any adverse coagulation events in our institute, thanks to the implementation of countermeasures involving mandatory connection of all catheters to a pressurized heparinized saline bag for the purpose of flushing, with catheter irrigation performed every 15 minutes. 4 , 5 …”

“…Further, the method is easily repeated due to the short ICG washout time, unlike intravenous ICG videoangiography. 4 , 5 Here, we present two cases of CCJ AVFs in which intraarterial ICG videoangiography proved useful for accurate diagnosis and successful treatment. Intraarterial ICG videoangiography was approved by the ethics review board at Tokushima University.…”

“… 2 , 3 We previously reported the usefulness of intraarterial ICG videoangiography for arteriovenous malformation and hemangioblastoma surgery. 4 , 5 This technique helps surgeons understand the angioarchitecture of vascular malformation more easily than with intravenous ICG videoangiography because of brighter and higher phase contrast. Further, the method is easily repeated due to the short ICG washout time, unlike intravenous ICG videoangiography.…”

Emerging therapies of hemangioblastomas

“…While GTR has been significantly correlated to improved overall survival rates, further studies are needed to determine the association of these methods with the progression-free survival rate. Furthermore, while 5-ALA has been useful in identifying tumor margins, it has yet to show replicability in guiding surgical strategies through randomized clinical trials [35]. Additionally, visual fluorescence using 5-ALA in specifically intramedullary HBs is limited due to the morphological features of these tumors not collecting 5-ALA [35].…”