Videoangiography for meningioma surgery

1. Does Icg Videoangiography Help in
Preserving Venous Outflow in Surgery
for Parasagittal Meningiomas ?
F. Tomasello, S. Cardali, A. Conti, F.F. Angileri
Department of Neurosurgery
University of Messina, ITALY

3. Surgical strategy
• Maximize microsurgical resection, preserving
the venous outflow
• If the SSS was occluded, but alternative
venous outflow was clearly recognized, the
tumor was resected together with the sinus
without further flow restoration
• ICG videoangiography was used in the last
cases and allowed a clear intraoperative
picture of venous outflow and collateral
circulation.

4. 28.4%
52.2%
19.4 %
Patients population
(1990-2012)
n = 71 43 28
Age = 59 (range 18-81)

5. Results
Follow-up 80 months (range 3-260)
Simpson 1 22.5 % (n=16)
Simpson 2 39.4 % (n=28)
Simpson 3 25.4 % (n=18)
Simpson 4 12.7 % (n=9)
Mortality 4.2% (n=3)
Morbidity 10.4%
Recurrence rate 10.4%
87.3%

6. Recent published series
Author,
year
n. Intrasinusal tumor management Recur.
rate (%)
Mor
bid.
(%)
Mort
ality
(%)
DiMeco et al.
(2004)
108 Marginal resection and dissection of the intraluminal
fragments from the sinus walls
13.9 11.1 1.8
Colli et al.
(2006)
53 No attempt to radical resection in cases of sinus
invasion
17.5 7.8 7.3
Caroli et al.
(2006)
328 “marginal resection” in cases of patent sinus 11.6 0.1 0
Sindou and
Alvernia (2006)
92 Radical resection and sinus reconstruction 4 8 3
Nowak et al.
(2007)
50 21 patients with sinus invasion. In 9 radical resection
was performed without flow restoration
18.4 6 4
Raza et al.
(2010)
61 Type III and IV radical resection and sinus
reconstruction
11 8.5 1.5
Sughrue et al.
(2011)
61 Microsurgical resection in cases of minimal sinus
invasion. Subtotal resection and SRS in cases with
major sinus involvement
4.9 19 0
Present series
(2013 in press)
71 Microsurgical resection without removal of the
intrasinusal portion.
10.4 10.4 4.2

9. Pre-operative DSA
Post-operative MR
venography

12. Pre-operative DSA
Post-operative MR
venography

13. Methods
• ICG videoangiography
– ICG 25 mg in 5 ml saline i.v.
– Fluorescence appeared in 5-10”
– Image clearance within 15 min
– Repeated as needed on surgeon request

15. Type I

17. Checking of bridging veins before dural opening

20. Venous patency after tumor resection

22. Type V

23. Venous outflow pattern before tumor resection

24. Venous outflow pattern after tumor resection

26. Scar as possible
limitation in detecting
flow inside vessels

27. Conclusions
• ICG videoangiography is a reliable, simple, non
invasive and low cost method to
intraoperatively assess the anatomy and
patency of venous outflow since dural
opening
• It can be performed repeatedly to monitor
vessel patency during resection and eventually
guide venous sacrifice
• Major limitations are
– Only exposed vessels can be evaluated
– Calcification, thick wall, scar or partial thrombosis
may potentially lead to false negative results