Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography
Patient 4: A 17-year-old male was admitted with moderate dysesthetic pain radiating from the posterior neck to the right upper extremity. Assessment of neurological condition before surgery suggested Grade 1 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 formation at C6/7 accompanying extensive syrinx []. The tumor was enhanced on T1-weighted MRIs []. Imaging diagnosis before surgery was intramedullary hemangioblastoma.\nThe patient underwent C5 to C7 osteoplastic laminotomy for total resection of the tumor. The spinal cord appeared slightly swollen []. Feeding arteries to the tumor were well differentiated from draining veins [], and were intercepted just proximal to the tumor. Blood flow to the tumor decreased during occlusion of feeding arteries []. Thick and cloudy pia mater encircling the tumor was cut sharply to reveal the clear gliosis layer of tumor–cord interface []. The tumor was completely removed in an en bloc fashion under the microscope []. When tumor removal was complete, there was little or no need for further hemostasis. ICG-VA after en bloc complete removal of the tumor revealed no sign of residual tumor and well preserved posterior spinal artery []. The pial edges were sutured together as much as possible to restore the shape of the spinal cord. Supplemental digital content of surgical was provided.\nT2-weighted MRIs obtained 3 months after surgery showed complete resection of the tumor []. Assessment of neurological condition at 3 months after surgery suggested Grade 1 on the modified McCormick functional schema and Grade 1 on the sensory pain scale.