Intraoperative assessment of spinal vascular flow in the surgery of spinal intramedullary tumors using indocyanine green videoangiography
Patient 3: A 42-year-old female was admitted with back pain, gait disturbance, and moderate dysesthesia of right upper extremity. Symptoms were more apparent in the upper extremities than in the lower extremities. Assessment of neurological condition before surgery suggested Grade 3 on the modified McCormick functional schema and Grade 3 on the sensory pain scale. T2-weighted magnetic resonance images (MRIs) of the cervical spine showed local enlargement and intramedullary mixed signal of the spinal cord at C6 []. T2*-weighted gradient-echo MRIs showed mixed low signal within the spinal cord [], which was consistent with blood degradation products. Imaging diagnosis before surgery was intramedullary hemorrhage associated with cavernous malformation.\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 appeared 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 intramedullary hemorrhage. Careful dissection within the spinal cord revealed the tumor–cord interface with the surrounding hemosiderin-stained tissue. The tumor was removed segmentally. The surrounding hemosiderin-stained tissue was not resected to avoid the damage of spinal tissue []. Posterior sulcal central veins were well visualized []. 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 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.