1. “The use of Indocyanine Green
videoangiography to optimize the dural
opening for intracranial parasagittal
lesions”
Nussbaum et al
Operative Neurosurgery March 2012

2. Reasons to choose the article
• Parasagittal Meningioma coming soon
• The issue was raised in previous meeting
• the availability of the material

3. National Brain Aneurysm Centre
St joseph’s Hospital, St Paul, MN

4. • Technical note
• A series of 3 cases
• Optimization of dural opening in
parasagittal lesions
• Delineation of the cortical draining
veins before dural opening

5. • To avoid cortical venous injury

6. Method
• exposure of the dura
• IV injection of 0.25mg/kg of IGC
• Microscope with light source with a wave length ICG
absorption
• Visualization of the venous structure in real time
• Marking of the visualized cortical veins
• Strategic planning of the dura

7. Case 1
• 73 year old female
• confusion/leg weakness
• large parasagittal mass
• Method as previously
described

8. • Video

9. Post Operative MRI

10. • First description of the use of ICG
videoangiography to protect cortical
draining veins
• Injury to draining veins can be disastrous
• Simple technique that can potentially
prevent severe venous infarction

11. Conclusion
• Safe
• Fast
• Inexpensive
• Accurate
• “can be utilised to assess the risk of sacrificing particular
vein”