Quantitative Analysis of Near-Infrared Indocyanine Green Videoangiography for Predicting Functional Outcomes After Spinal Intramedullary Ependymoma Resection.

Abstract

BACKGROUND\nOne of the most critical steps in surgery for spinal intramedullary ependymomas is the resection of small feeding arteries from the anterior spinal artery with anatomical preservation of the normal circulation of the ventral spinal cord.\n\n\nOBJECTIVE\nTo quantitatively analyze the microcirculation of the ventral spinal cord by near-infrared indocyanine green videoangiography (ICG-VA) after the spinal intramedullary ependymoma resection.\n\n\nMETHODS\nThis retrospective study included 12 patients (7 male and 5 female; average age 55.2 years, range 36-79 years). Patients neurological conditions were assessed based on the modified McCormick functional schema of grade 1 (neurologically normal) to 5 (severe deficit). Postoperative functional assessment was conducted at least 3 months after surgery. Quantitative analysis of vascular flow dynamics was carried out following spinal intramedullary ependymoma resection. Fluorescence intensities were measured and the indocyanine green (ICG) intensity-time curves were analyzed and compared with the functional outcomes after surgery.\n\n\nRESULTS\nMicroscopically total or subtotal resection of the intramedullary ependymoma was achieved in all cases. Average peak time on ICG-VA was significantly shorter in the postoperative functional grade 1 to 2 group than in the postoperative functional grade 3 to 5 group, but there was no significant difference in average peak intensity between the 2 groups. Postoperative functional grade and the peak time of ICG, but not peak intensity, appeared correlated.\n\n\nCONCLUSION\nTo the best of our knowledge, this is the first report showing that quantitative analysis of ICG-VA may predict functional outcomes after spinal intramedullary ependymoma resection.