icg and parasagittal lesions akil

“The use of Indocyanine Green videoangiography to optimize the

dural opening for intracranial parasagittal lesions”

Nussbaum et alOperative Neurosurgery March 2012

Reasons to choose the article

•Parasagittal Meningioma coming soon

•The issue was raised in previous meeting

•the availability of the material

National Brain Aneurysm CentreSt joseph’s Hospital, St Paul, MN

•Technical note

•A series of 3 cases

•Optimization of dural opening in parasagittal lesions

•Delineation of the cortical draining veins before dural opening

•To avoid cortical venous injury

• exposure of the dura

• IV injection of 0.25mg/kg of IGC

•Microscope with light source with a wave length ICG absorption

• Visualization of the venous structure in real time

•Marking of the visualized cortical veins

• Strategic planning of the dura

Method

Case 1

• 73 year old female

• confusion/leg weakness

• large parasagittal mass

•Method as previously described

•Video

Post Operative MRI

•First description of the use of ICG videoangiography to protect cortical draining veins

•Injury to draining veins can be disastrous

•Simple technique that can potentially prevent severe venous infarction

• Safe

• Fast

• Inexpensive

• Accurate

• “can be utilised to assess the risk of sacrificing particular vein”

Conclusion