Identification of venous sinus, tumor location, and pial supply during meningioma surgery by transdural indocyanine green videography

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Indocyanine green (ICG) videography is commonly used in the neurosurgical field for minimally invasive neurosurgery. The aim of this study was to evaluate a new intraoperative imaging modality by performing transdural ICG videography during surgery for meningiomas.


Between March 2011 and April 2012, 10 patients with meningiomas received intravenous injection of 12.5 mg ICG just prior to dural opening. The cases comprised 8 convexity meningiomas and 2 foramen magnum meningiomas. Efficacy of the transdural ICG videography was assessed in terms of the tumor volume, the circulation time from the first appearance of the vessel to the appearance of the venous sinus, the tendency to bleed, and the discrimination of the venous sinus.


The mean tumor volume was 71.6 ± 87.9 ml (the mean is expressed ± SD throughout). The cortical arteries, veins, and the venous sinus were identified by the ICG videography transdurally. The projection of the meningiomas was identified by a shadow (which the authors call the eclipse sign). Total eclipse signs were obtained in 8 cases and partial eclipse signs were obtained in 2 cases; tumor volume in the latter was more than 200 ml. In 5 of 10 cases the adjacent venous sinuses were exposed and were successfully visualized by ICG videography in 5.92 ± 1.05 seconds from the first appearance of the vessel. In 5 of 10 cases the total and the partial eclipse signs were diminished in 3.46 ± 1.31 seconds. The diminishment of the total and the partial eclipse sign was earlier than the visualization of the venous sinus (p = 0.011, t-test), revealing bleeding from the tumor that was observed until coagulation of the feeding arteries from the intracranial arteries.


Prior to opening of the dura mater, transdural ICG videography was used successfully to visualize the dural attachment of meningiomas and the venous sinus, resulting in safe and appropriate dural opening. The diminishment of the total and partial eclipse signs may represent significant feeding from the intracranial arteries and a tendency to bleed during resection.

Abbreviations used in this paper:ECA = external carotid artery; ICA = internal carotid artery; ICG = indocyanine green; VA = vertebral artery.

Article Information

Address correspondence to: Tetsuya Ueba, M.D., Department of Neurosurgery, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jounan-ku, Fukuoka 814-0180, Japan. email:

Please include this information when citing this paper: published online January 11, 2013; DOI: 10.3171/2012.11.JNS121113.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Gadolinium-enhanced MR images obtained in 3 representative cases. A: Case 7. The MR images show that the tumor is located next to the transverse sinus. B: Case 6. The MR images show that the cerebellar convexity meningioma is next to the transverse-sigmoid sinus junction. C: Case 10. The MR images show the large convexity meningioma.

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    Intraoperative photographs and images of the total eclipse sign and the partial eclipse sign and their diminishment. A: Case 7. The total eclipse sign can be identified at the early and late phase of the ICG videography. No bleeding during the tumor resection can be observed. The asterisk designates the transverse sinus. B: Case 6. The total eclipse sign can be identified at the early phase of the ICG videography; however, the sign is diminished at the late phase (double asterisks). Significant bleeding can be observed during the tumor resection. C: Case 10. The partial eclipse sign can be identified at the early phase of the ICG videography; the border of the partial eclipse sign is indicated by the arrows. The partial eclipse sign is diminished at the late phase; the border of the diminishment is indicated by triangles. Significant bleeding can be observed during the tumor resection until the coagulation of the feeding arteries from the pial arteries, and significant pial invasion can be observed.



Awano TSakatani KYokose NKondo YIgarashi THoshino T: Intraoperative EC-IC bypass blood flow assessment with indocyanine green angiography in moyamoya and non-moyamoya ischemic stroke. World Neurosurg 73:6686742010


Czabanka MPeña-Tapia PSchubert GAWoitzik JVajkoczy PSchmiedek P: Characterization of cortical microvascularization in adult moyamoya disease. Stroke 39:170317092008


Faber FThon NFesl GRachinger WGuckler RTonn JC: Enhanced analysis of intracerebral arterioveneous malformations by the intraoperative use of analytical indocyanine green videoangiography: technical note. Acta Neurochir (Wien) 153:218121872011


Ferroli PAcerbi FAlbanese ETringali GBroggi MFranzini A: Application of intraoperative indocyanine green angiography for CNS tumors: results on the first 100 cases. Acta Neurochir Suppl 109:2512572011


Ferroli PAcerbi FTringali GAlbanese EBroggi MFranzini A: Venous sacrifice in neurosurgery: new insights from venous indocyanine green videoangiography. Clinical article. J Neurosurg 115:18232011


Haga SNagata SUka AAkagi YHamada YShono T: Near-infrared indocyanine green videoangiography for assessment of carotid endarterectomy. Acta Neurochir (Wien) 153:164116442011


Horie NSo GDebata AHayashi KMorikawa MSuyama K: intraarterial indocyanine green angiography in the management of spinal arteriovenous fistulae: technical case reports. Spine (Phila Pa 1976) 37:E264E2672012


Kim EHCho JMChang JHKim SHLee KS: Application of intraoperative indocyanine green videoangiography to brain tumor surgery. Acta Neurochir (Wien) 153:148714952011


Kimura TMuguruma NIto SOkamura SImoto YMiyamoto H: Infrared fluorescence endoscopy for the diagnosis of superficial gastric tumors. Gastrointest Endosc 66:37432007


Kogure KDavid NJYamanouchi UChoromokos E: Infrared absorption angiography of the fundus circulation. Arch Ophthalmol 83:2092141970


LeRoux PDBerger MSOjemann GAWang KMack LA: Correlation of intraoperative ultrasound tumor volumes and margins with preoperative computerized tomography scans. An intraoperative method to enhance tumor resection. J Neurosurg 71:6916981989


Murai YAdachi KKoketsu KTeramoto A: Indocyanine green videoangiography of optic cavernous angioma—Case report. Neurol Med Chir (Tokyo) 51:2962982011


Murai YAdachi KMatano FTateyama KTeramoto A: Indocyanin green videoangiography study of hemangioblastomas. Can J Neurol Sci 38:41472011


Raabe ABeck JGerlach RZimmermann MSeifert V: Near-infrared indocyanine green video angiography: a new method for intraoperative assessment of vascular flow. Neurosurgery 52:1321392003


Schubert GABarth MThomé C: The use of indocyanine green videography for intraoperative localization of intradural spinal tumors. Spine (Phila Pa 1976) 35:E212E2172010


Schuette AJDannenbaum MJCawley CMBarrow DL: Indocyanine green videoangiography for confirmation of bypass graft patency. J Korean Neurosurg Soc 50:23292011


Ueba TAbe HHigashi TInoue T: Transdural imaging of meningiomas by indocyanine green videography: the eclipse sign. J Neurol Surg A Cent Eur Neurosurg [epub ahead of print]2012


Woitzik JHorn PVajkoczy PSchmiedek P: Intraoperative control of extracranial-intracranial bypass patency by near-infrared indocyanine green videoangiography. J Neurosurg 102:6926982005




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