Use of a near-infrared vein finder to define cortical veins and dural sinuses prior to dural opening

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  • Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Near-infrared (NIR) light is commonly used to map venous anatomy in the upper extremities to gain intravenous access for line placement. In this report, the authors describe the use of a common and commercially available NIR vein finder to delineate the cortical venous anatomy prior to dural opening.

During a variety of cranial approaches, the dura was directly visualized using an NIR vein finder. The NIR light source allowed for recognition of the underlying cortical venous anatomy, dural sinuses, and underlying pathology before the dura was opened. This information was considered when tailoring the dural opening. When the dura was illuminated with the NIR vein finder, the underlying cortical and sinus venous anatomy was evident and correlated with the observed cortical anatomy. The vein finder was also accurate in locating superficial lesions and pathological dural veins. A complete accordance in the findings on the pre– and post–dural opening images was observed in all cases.

This simple, inexpensive procedure is readily compatible with operative room workflow, necessitates no head fixation, and offers a real-time image independent of brain shift.

ABBREVIATIONS dAVF = dural arteriovenous fistula; ICG-VA = indocyanine green videoangiography; MCA = middle cerebral artery; NIR = near-infrared.

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Contributor Notes

Correspondence Ezequiel Goldschmidt: University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center, UPMC Presbyterian Hospital, Pittsburgh, PA. goldschmidted@upmc.edu.

INCLUDE WHEN CITING Published online August 2, 2019; DOI: 10.3171/2019.5.JNS19297.

Disclosures Dr. Gardner reports owning stock in SPIWay and giving a sponsored talk on behalf of Zeiss.

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