Application of intraoperative indocyanine green videoangiography for resection of spinal cord hemangioblastoma: advantages and limitations.

Hemangioblastomas constitute 2-15% of intramedullary spinal cord tumors. Identification of the feeding arteries and draining veins is crucial for an en bloc tumor resection and cure. We report our experience using intraoperative indocyanine green (ICG) videoangiography during the surgical resection of spinal cord hemangioblastomas (SH) and evaluate the advantages and limitations of this technique. Seven patients with an SH underwent resection with the assistance of intraoperative ICG videoangiography. The ICG videoangiography images were analyzed, and the preoperative, intraoperative, and postoperative images were compared. ICG videoangiography clearly revealed the feeding arteries and enlarged draining veins and assisted in defining the tumor borders in five of the seven patients (patients one, two, four, five, and seven). By contrast, patient three had a devascularized residual tumor located deep in the spinal cord parenchyma, which did not take up the fluorescent dye and therefore was not visualized by ICG videoangiography. In addition, in patient six, only the draining veins could be visualized in the ventrolateral tumor, because it was covered by the spinal cord parenchyma. Six tumors were completely removed, and one was partially removed. None of our patients had significant neurological deterioration after surgery. ICG videoangiography provided real-time information about the tumor vasculature during surgery for SH and aided in intraoperative decision-making. However, for deep tumors and ventral tumors, the benefits of this technique might be limited.