Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography
Patient 12: A 46-year-old female was admitted with severe dysesthetic pain radiating from the posterior neck to the right upper extremity. Assessment of neurological condition before surgery suggested Grade 2 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted MRIs of the cervical spine showed an intramedullary tumor with syrinx formation at C6 []. The tumor was well enhanced on T1-weighted images []. Imaging diagnosis before surgery was intramedullary ependymoma.\nThe patient underwent C5 to C7 osteoplastic laminotomy for evacuation of the intramedullary hemorrhage and total resection of the tumor. The spinal cord appeared slightly swollen []. Posterior spinal arteries on both sides were well differentiated from posterior spinal veins and the pial venous plexus []. Venous circulation of posterior spinal veins and the pial venous plexus was stagnant []. Crossing veins on the PMS were coagulated with a microbipolar coagulator at very low power levels under continuous saline irrigation. A PMS approach to the spinal cord revealed the tumor surface. Careful dissection within the spinal cord revealed the tumor–cord interface with the surrounding gliotic tissue. The tumor was removed in an en bloc fashion. Sulcal central branches of the anterior spinal artery were well preserved [Figure and ]. The surrounding gliotic tissue was not resected to avoid the damage of spinal tissue []. The pial edges were sutured together as much as possible to restore the shape of the spinal cord.\nT2-weighted MRIs obtained 3 months after surgery showed satisfactory recovery of the intramedullary signal of the spinal cord []. Assessment of neurological condition at 3 months after surgery suggested Grade 2 on the modified McCormick functional schema and Grade 2 on the sensory pain scale.