Importance of collateral venous circulation on indocyanine green videoangiography in intracranial meningioma resection: direct evidence for venous compression theory in peritumoral edema formation

View More View Less
  • 1 Departments of Neurosurgery and
  • 2 Pathology, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Jeollanam-do, South Korea
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

Indocyanine green videoangiography (ICGVA) has been used in many neurosurgical operations, including vascular and brain tumor fields. In this study, the authors applied ICGVA to intracranial meningioma surgery and evaluated it usefulness with attention to collateral venous flow.

METHODS

Forty-two patients with intracranial meningioma who underwent ICGVA during microsurgical resection were retrospectively analyzed. For ICGVA, the ICG was injected intravenously at the standard dose of 12.5 mg before and/or after tumor resection. Intravascular fluorescence from blood vessels was imaged through a microscope with a special filter and infrared excitation light to illuminate the operating field. The authors assessed the benefits of ICGVA and analyzed its findings with preoperative radiological findings on MRI.

RESULTS

ICGVA allowed real-time assessment of the patency and flow direction in very small peritumoral vessels in all cases. A safe dural incision could also be done based on information from ICGVA. The collateral venous channel due to venous obstruction of tumoral compression was found in 10 cases, and venous flow restoration after tumor resection was observed promptly after tumor resection in 4 cases. Peritumoral brain edema (PTBE) was observed on preoperative T2-weighted MRI in 19 patients. The presence of collateral venous circulation or flow restoration was significantly related to PTBE formation in multivariate analysis (p = 0.001; HR 0.027, 95% CI 0.003–0.242).

CONCLUSIONS

ICGVA, an excellent method for monitoring blood flow during meningioma resection, provides valuable information as to the presence of venous collaterals and flow restoration. Furthermore, the fact that the presence of venous collaterals was found to be associated with PTBE may directly support the venous theory as the pathogenesis of PTBE formation.

ABBREVIATIONS DSA = digital subtraction angiography; ICG = indocyanine green; ICGVA = indocyanine green videoangiography; MDS = microvascular Doppler sonography; PTBE = peritumoral brain edema; SSS = superior sagittal sinus.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Shin Jung: Chonnam National University Hwasun Hospital and Medical School, Jeollanam-do, South Korea. sjung@chonnam.ac.kr.

INCLUDE WHEN CITING Published online May 24, 2019; DOI: 10.3171/2019.3.JNS182308.

J.H.K. and K.S.M. contributed equally to this work and share first authorship.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Alaywan M, Sindou M: [Prognostic factors in the surgery for intracranial meningioma. Role of the tumoral size and arterial vascularization originating from the pia mater. Study of 150 cases.] Neurochirurgie 39:337347, 1993 (French)

    • Search Google Scholar
    • Export Citation
  • 2

    Arienta C, Caroli M, Crotti F, Villani R: Treatment of intracranial meningiomas in patients over 70 years old. Acta Neurochir (Wien) 107:4755, 1990

    • Search Google Scholar
    • Export Citation
  • 3

    Berhouma M, Jacquesson T, Jouanneau E, Cotton F: Pathogenesis of peri-tumoral edema in intracranial meningiomas. Neurosurg Rev 42:5971, 2019

    • Search Google Scholar
    • Export Citation
  • 4

    Bitzer M, Topka H, Morgalla M, Friese S, Wöckel L, Voigt K: Tumor-related venous obstruction and development of peritumoral brain edema in meningiomas. Neurosurgery 42:730737, 1998

    • Search Google Scholar
    • Export Citation
  • 5

    Bitzer M, Wöckel L, Luft AR, Wakhloo AK, Petersen D, Opitz H, : The importance of pial blood supply to the development of peritumoral brain edema in meningiomas. J Neurosurg 87:368373, 1997

    • Search Google Scholar
    • Export Citation
  • 6

    Bitzer M, Wöckel L, Morgalla M, Keller C, Friese S, Heiss E, : Peritumoural brain oedema in intracranial meningiomas: influence of tumour size, location and histology. Acta Neurochir (Wien) 139:11361142, 1997

    • Search Google Scholar
    • Export Citation
  • 7

    Dashti R, Laakso A, Niemelä M, Porras M, Hernesniemi J: Microscope-integrated near-infrared indocyanine green videoangiography during surgery of intracranial aneurysms: the Helsinki experience. Surg Neurol 71:543550, 2009

    • Search Google Scholar
    • Export Citation
  • 8

    d’Avella E, Volpin F, Manara R, Scienza R, Della Puppa A: Indocyanine green videoangiography (ICGV)-guided surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS). Acta Neurochir (Wien) 155:415420, 2013

    • Search Google Scholar
    • Export Citation
  • 9

    de Oliveira JG, Beck J, Seifert V, Teixeira MJ, Raabe A: Assessment of flow in perforating arteries during intracranial aneurysm surgery using intraoperative near-infrared indocyanine green videoangiography. Neurosurgery 62 (6 Suppl 3):13001310, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    de Vries J, Wakhloo AK: Cerebral oedema associated with WHO-I, WHO-II, and WHO-III-meningiomas: correlation of clinical, computed tomographic, operative and histological findings. Acta Neurochir (Wien) 125:3440, 1993

    • Search Google Scholar
    • Export Citation
  • 11

    Della Puppa A, Rustemi O, Gioffrè G, Rolma G, Grandis M, Munari M, : Application of indocyanine green video angiography in parasagittal meningioma surgery. Neurosurg Focus 36(2):E13, 2014

    • Search Google Scholar
    • Export Citation
  • 12

    Ferroli P, Acerbi F, Albanese E, Tringali G, Broggi M, Franzini A, : Application of intraoperative indocyanine green angiography for CNS tumors: results on the first 100 cases. Acta Neurochir Suppl 109:251257, 2011

    • Search Google Scholar
    • Export Citation
  • 13

    Ferroli P, Acerbi F, Broggi M, Broggi G: Arteriovenous micromalformation of the trigeminal root: intraoperative diagnosis with indocyanine green videoangiography: case report. Neurosurgery 67 (3 Suppl Operative):E309E310, 2010

    • Search Google Scholar
    • Export Citation
  • 14

    Go KG, Wilmink JT, Molenaar WM: Peritumoral brain edema associated with meningiomas. Neurosurgery 23:175179, 1988

  • 15

    Hänggi D, Etminan N, Steiger HJ: The impact of microscope-integrated intraoperative near-infrared indocyanine green videoangiography on surgery of arteriovenous malformations and dural arteriovenous fistulae. Neurosurgery 67:10941104, 2010

    • Search Google Scholar
    • Export Citation
  • 16

    Hou J, Kshettry VR, Selman WR, Bambakidis NC: Peritumoral brain edema in intracranial meningiomas: the emergence of vascular endothelial growth factor-directed therapy. Neurosurg Focus 35(6):E2, 2013

    • Search Google Scholar
    • Export Citation
  • 17

    Imizu S, Kato Y, Sangli A, Oguri D, Sano H: Assessment of incomplete clipping of aneurysms intraoperatively by a near-infrared indocyanine green-video angiography (Niicg-Va) integrated microscope. Minim Invasive Neurosurg 51:199203, 2008

    • Search Google Scholar
    • Export Citation
  • 18

    Jacobs K, Moulin T, Bogousslavsky J, Woimant F, Dehaene I, Tatu L, : The stroke syndrome of cortical vein thrombosis. Neurology 47:376382, 1996

    • Search Google Scholar
    • Export Citation
  • 19

    Killory BD, Nakaji P, Gonzales LF, Ponce FA, Wait SD, Spetzler RF: Prospective evaluation of surgical microscope-integrated intraoperative near-infrared indocyanine green angiography during cerebral arteriovenous malformation surgery. Neurosurgery 65:456462, 2009

    • Search Google Scholar
    • Export Citation
  • 20

    Kim EH, Cho JM, Chang JH, Kim SH, Lee KS: Application of intraoperative indocyanine green videoangiography to brain tumor surgery. Acta Neurochir (Wien) 153:14871495, 2011

    • Search Google Scholar
    • Export Citation
  • 21

    Kiya K, Satoh H, Mizoue T, Kinoshita Y: Postoperative cortical venous infarction in tumours firmly adherent to the cortex. J Clin Neurosci 8 (Suppl 1):109113, 2001

    • Search Google Scholar
    • Export Citation
  • 22

    Lieu AS, Howng SL: Intracranial meningiomas and epilepsy: incidence, prognosis and influencing factors. Epilepsy Res 38:4552, 2000

  • 23

    Murai Y, Adachi K, Matano F, Tateyama K, Teramoto A: Indocyanin green videoangiography study of hemangioblastomas. Can J Neurol Sci 38:4147, 2011

    • Search Google Scholar
    • Export Citation
  • 24

    Nakano T, Asano K, Miura H, Itoh S, Suzuki S: Meningiomas with brain edema: radiological characteristics on MRI and review of the literature. Clin Imaging 26:243249, 2002

    • Search Google Scholar
    • Export Citation
  • 25

    Raabe A, Beck J, Gerlach R, Zimmermann M, Seifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:132139, 2003

    • Search Google Scholar
    • Export Citation
  • 26

    Sindou M: Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci 8 (Suppl 1):811, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Sindou MP, Alaywan M: Most intracranial meningiomas are not cleavable tumors: anatomic-surgical evidence and angiographic predictibility. Neurosurgery 42:476480, 1998

    • Search Google Scholar
    • Export Citation
  • 28

    Vignes JR, Sesay M, Rezajooi K, Gimbert E, Liguoro D: Peritumoral edema and prognosis in intracranial meningioma surgery. J Clin Neurosci 15:764768, 2008

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 146 146 56
Full Text Views 86 86 52
PDF Downloads 139 139 103
EPUB Downloads 0 0 0