Utility of intraoperative fluorescence imaging with indocyanine green for diagnosing spinal schwannoma: A case report

Abstract

Background: The delayed-window indocyanine green (DWICG) technique is useful for the removal of brain and spinal tumors. Case Description: A 41-year-old female presented with lower left back and radicular pain. An magnetic resonance imaging (MRI) revealed an extramedullary L3 lesion located ventrally in the spinal canal that appeared to be a schwannoma. Intravenous indocyanine green (dose, 0.25 mg/kg) was administered 1 h before the L2–L4 laminectomy and L3/L4 posterior lumbar fusion. At surgery utilizing a strong near-infrared (NIR) signal, the tumor was clearly visualized through the dura. Complete tumor excision was confirmed when the NIR signal could no longer be detected. Pathologically, the lesion proved to be a schwannoma. A postoperative MRI scan further confirmed complete tumor excision. Conclusion: In a 41-year-old female, the DWICG technique intraoperatively facilitated localization of a L3 schwannoma through the dura and expedited gross total tumor removal.