The role of indocyanine green videoangiography with FLOW 800 analysis for the surgical management of central nervous system tumors

An update

Francesco Acerbi, Ignazio G. Vetrano, Tommaso Sattin, Camilla de Laurentis, Lorenzo Bosio, Zefferino Rossini, Morgan Broggi, Marco Schiariti, Paolo Ferroli

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE Indocyanine green videoangiography (ICG-VA) is an intraoperative technique used to highlight vessels in neurovascular surgery. Its application in the study of the vascular pathophysiology in CNS tumors and its role in their surgical management are still rather limited. A recent innovation of ICG-VA (i.e., the FLOW 800 algorithm integrated in the surgical microscope) allows a semiquantitative evaluation of cerebral blood flow. The aim of this study was to evaluate for the first time the systematic application of ICG-VA and FLOW 800 analysis during surgical removal of CNS tumors. METHODS Between May 2011 and December 2017, all cases in which ICG-VA and FLOW 800 analysis were used at least one time before, during, or after the tumor resection, and in which surgical videos were available, were retrospectively reviewed. Results of the histological analysis were analyzed together with the intraoperative ICG-VA with FLOW 800 in order to investigate the tumor-related videoangiographic features. RESULTS Seventy-one patients who underwent surgery for cerebral and spinal tumors were intraoperatively analyzed using ICG-VA with FLOW 800, either before or after tumor resection, for a total of 93 videoangiographic studies. The histological diagnosis was meningioma in 25 cases, glioma in 14, metastasis in 7, pineal region tumor in 5, hemangioblastoma in 4, chordoma in 3, and other histological types in 13 cases. The authors identified 4 possible applications of ICG-VA and FLOW 800 in CNS tumor surgery: extradural surveys allowed exploration of sinus patency and the course of veins before dural opening; preresection surveys helped in identifying pathological vascularization (arteriovenous fistulas and neo-angiogenesis) and regional venous outflow, and in performing temporary venous clipping tests, when necessary; postresection surveys were conducted to evaluate arterial and venous patency and parenchymal perfusion after tumor removal; and a premyelotomy survey was conducted in intramedullary tumors to highlight the posterior median sulcus. CONCLUSIONS The authors found ICG-VA with FLOW 800 to be a useful method to monitor blood flow in the exposed vessels and parenchyma during microsurgical removal of CNS tumors in selected cases. In particular, a preresection survey provides useful information about pathophysiological changes of brain vasculature related to the tumor and aids in the individuation of helpful landmarks for the surgical approach, and the postresection survey helps to prevent potential complications associated with the resection (such as local hypoperfusion or venous infarction).

Original languageEnglish
Article numberE6
JournalNeurosurgical Focus
Volume44
Issue number6
DOIs
Publication statusPublished - Jun 1 2018

Fingerprint

Central Nervous System Neoplasms
Indocyanine Green
Neoplasms
Cerebrovascular Circulation
Pinealoma
Individuation
Hemangioblastoma
Chordoma
Arteriovenous Fistula
Meningioma
Glioma
Infarction
Blood Vessels
Surveys and Questionnaires
Veins
Perfusion

Keywords

  • CNS tumors
  • FLOW 800
  • ICG
  • Indocyanine green
  • Software analysis
  • Videoangiography

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

The role of indocyanine green videoangiography with FLOW 800 analysis for the surgical management of central nervous system tumors : An update. / Acerbi, Francesco; Vetrano, Ignazio G.; Sattin, Tommaso; de Laurentis, Camilla; Bosio, Lorenzo; Rossini, Zefferino; Broggi, Morgan; Schiariti, Marco; Ferroli, Paolo.

In: Neurosurgical Focus, Vol. 44, No. 6, E6, 01.06.2018.

Research output: Contribution to journalArticle

@article{0b90c6004b9a434c878247b5aa2cd106,
title = "The role of indocyanine green videoangiography with FLOW 800 analysis for the surgical management of central nervous system tumors: An update",
abstract = "OBJECTIVE Indocyanine green videoangiography (ICG-VA) is an intraoperative technique used to highlight vessels in neurovascular surgery. Its application in the study of the vascular pathophysiology in CNS tumors and its role in their surgical management are still rather limited. A recent innovation of ICG-VA (i.e., the FLOW 800 algorithm integrated in the surgical microscope) allows a semiquantitative evaluation of cerebral blood flow. The aim of this study was to evaluate for the first time the systematic application of ICG-VA and FLOW 800 analysis during surgical removal of CNS tumors. METHODS Between May 2011 and December 2017, all cases in which ICG-VA and FLOW 800 analysis were used at least one time before, during, or after the tumor resection, and in which surgical videos were available, were retrospectively reviewed. Results of the histological analysis were analyzed together with the intraoperative ICG-VA with FLOW 800 in order to investigate the tumor-related videoangiographic features. RESULTS Seventy-one patients who underwent surgery for cerebral and spinal tumors were intraoperatively analyzed using ICG-VA with FLOW 800, either before or after tumor resection, for a total of 93 videoangiographic studies. The histological diagnosis was meningioma in 25 cases, glioma in 14, metastasis in 7, pineal region tumor in 5, hemangioblastoma in 4, chordoma in 3, and other histological types in 13 cases. The authors identified 4 possible applications of ICG-VA and FLOW 800 in CNS tumor surgery: extradural surveys allowed exploration of sinus patency and the course of veins before dural opening; preresection surveys helped in identifying pathological vascularization (arteriovenous fistulas and neo-angiogenesis) and regional venous outflow, and in performing temporary venous clipping tests, when necessary; postresection surveys were conducted to evaluate arterial and venous patency and parenchymal perfusion after tumor removal; and a premyelotomy survey was conducted in intramedullary tumors to highlight the posterior median sulcus. CONCLUSIONS The authors found ICG-VA with FLOW 800 to be a useful method to monitor blood flow in the exposed vessels and parenchyma during microsurgical removal of CNS tumors in selected cases. In particular, a preresection survey provides useful information about pathophysiological changes of brain vasculature related to the tumor and aids in the individuation of helpful landmarks for the surgical approach, and the postresection survey helps to prevent potential complications associated with the resection (such as local hypoperfusion or venous infarction).",
keywords = "CNS tumors, FLOW 800, ICG, Indocyanine green, Software analysis, Videoangiography",
author = "Francesco Acerbi and Vetrano, {Ignazio G.} and Tommaso Sattin and {de Laurentis}, Camilla and Lorenzo Bosio and Zefferino Rossini and Morgan Broggi and Marco Schiariti and Paolo Ferroli",
year = "2018",
month = "6",
day = "1",
doi = "10.3171/2018.3.FOCUS1862",
language = "English",
volume = "44",
journal = "Neurosurgical Focus",
issn = "1092-0684",
publisher = "American Association of Neurological Surgeons",
number = "6",

}

TY - JOUR

T1 - The role of indocyanine green videoangiography with FLOW 800 analysis for the surgical management of central nervous system tumors

T2 - An update

AU - Acerbi, Francesco

AU - Vetrano, Ignazio G.

AU - Sattin, Tommaso

AU - de Laurentis, Camilla

AU - Bosio, Lorenzo

AU - Rossini, Zefferino

AU - Broggi, Morgan

AU - Schiariti, Marco

AU - Ferroli, Paolo

PY - 2018/6/1

Y1 - 2018/6/1

N2 - OBJECTIVE Indocyanine green videoangiography (ICG-VA) is an intraoperative technique used to highlight vessels in neurovascular surgery. Its application in the study of the vascular pathophysiology in CNS tumors and its role in their surgical management are still rather limited. A recent innovation of ICG-VA (i.e., the FLOW 800 algorithm integrated in the surgical microscope) allows a semiquantitative evaluation of cerebral blood flow. The aim of this study was to evaluate for the first time the systematic application of ICG-VA and FLOW 800 analysis during surgical removal of CNS tumors. METHODS Between May 2011 and December 2017, all cases in which ICG-VA and FLOW 800 analysis were used at least one time before, during, or after the tumor resection, and in which surgical videos were available, were retrospectively reviewed. Results of the histological analysis were analyzed together with the intraoperative ICG-VA with FLOW 800 in order to investigate the tumor-related videoangiographic features. RESULTS Seventy-one patients who underwent surgery for cerebral and spinal tumors were intraoperatively analyzed using ICG-VA with FLOW 800, either before or after tumor resection, for a total of 93 videoangiographic studies. The histological diagnosis was meningioma in 25 cases, glioma in 14, metastasis in 7, pineal region tumor in 5, hemangioblastoma in 4, chordoma in 3, and other histological types in 13 cases. The authors identified 4 possible applications of ICG-VA and FLOW 800 in CNS tumor surgery: extradural surveys allowed exploration of sinus patency and the course of veins before dural opening; preresection surveys helped in identifying pathological vascularization (arteriovenous fistulas and neo-angiogenesis) and regional venous outflow, and in performing temporary venous clipping tests, when necessary; postresection surveys were conducted to evaluate arterial and venous patency and parenchymal perfusion after tumor removal; and a premyelotomy survey was conducted in intramedullary tumors to highlight the posterior median sulcus. CONCLUSIONS The authors found ICG-VA with FLOW 800 to be a useful method to monitor blood flow in the exposed vessels and parenchyma during microsurgical removal of CNS tumors in selected cases. In particular, a preresection survey provides useful information about pathophysiological changes of brain vasculature related to the tumor and aids in the individuation of helpful landmarks for the surgical approach, and the postresection survey helps to prevent potential complications associated with the resection (such as local hypoperfusion or venous infarction).

AB - OBJECTIVE Indocyanine green videoangiography (ICG-VA) is an intraoperative technique used to highlight vessels in neurovascular surgery. Its application in the study of the vascular pathophysiology in CNS tumors and its role in their surgical management are still rather limited. A recent innovation of ICG-VA (i.e., the FLOW 800 algorithm integrated in the surgical microscope) allows a semiquantitative evaluation of cerebral blood flow. The aim of this study was to evaluate for the first time the systematic application of ICG-VA and FLOW 800 analysis during surgical removal of CNS tumors. METHODS Between May 2011 and December 2017, all cases in which ICG-VA and FLOW 800 analysis were used at least one time before, during, or after the tumor resection, and in which surgical videos were available, were retrospectively reviewed. Results of the histological analysis were analyzed together with the intraoperative ICG-VA with FLOW 800 in order to investigate the tumor-related videoangiographic features. RESULTS Seventy-one patients who underwent surgery for cerebral and spinal tumors were intraoperatively analyzed using ICG-VA with FLOW 800, either before or after tumor resection, for a total of 93 videoangiographic studies. The histological diagnosis was meningioma in 25 cases, glioma in 14, metastasis in 7, pineal region tumor in 5, hemangioblastoma in 4, chordoma in 3, and other histological types in 13 cases. The authors identified 4 possible applications of ICG-VA and FLOW 800 in CNS tumor surgery: extradural surveys allowed exploration of sinus patency and the course of veins before dural opening; preresection surveys helped in identifying pathological vascularization (arteriovenous fistulas and neo-angiogenesis) and regional venous outflow, and in performing temporary venous clipping tests, when necessary; postresection surveys were conducted to evaluate arterial and venous patency and parenchymal perfusion after tumor removal; and a premyelotomy survey was conducted in intramedullary tumors to highlight the posterior median sulcus. CONCLUSIONS The authors found ICG-VA with FLOW 800 to be a useful method to monitor blood flow in the exposed vessels and parenchyma during microsurgical removal of CNS tumors in selected cases. In particular, a preresection survey provides useful information about pathophysiological changes of brain vasculature related to the tumor and aids in the individuation of helpful landmarks for the surgical approach, and the postresection survey helps to prevent potential complications associated with the resection (such as local hypoperfusion or venous infarction).

KW - CNS tumors

KW - FLOW 800

KW - ICG

KW - Indocyanine green

KW - Software analysis

KW - Videoangiography

UR - http://www.scopus.com/inward/record.url?scp=85047883913&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047883913&partnerID=8YFLogxK

U2 - 10.3171/2018.3.FOCUS1862

DO - 10.3171/2018.3.FOCUS1862

M3 - Article

VL - 44

JO - Neurosurgical Focus

JF - Neurosurgical Focus

SN - 1092-0684

IS - 6

M1 - E6

ER -