Utility of intraoperative real-time near-infrared fluorescence surgery for spinal schwannoma

Jun Muto; Yutaka Mine; Sota Nagai; Naoyuki Shizu; Hiroki Takeda; Daiki Ikeda; Akifumi Saito; Masahiro Joko; Mitsuhiro Hasegawa; Shinjiro Kaneko; Tatsushi Inoue; John Y K Lee; Yuichi Hirose

doi:10.3171/2021.10.FOCVID21158

Utility of intraoperative real-time near-infrared fluorescence surgery for spinal schwannoma

Neurosurg Focus Video. 2022 Jan 1;6(1):V12. doi: 10.3171/2021.10.FOCVID21158. eCollection 2022 Jan.

Authors

Affiliations

¹ Department of Neurosurgery, Fujita Health University, Toyoake.
² Department of Neurosurgery, Brain Nerve Center, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan; and.
³ Department of Orthopaedic Surgery, Fujita Health University, Toyoake.
⁴ Department of Spine and Spinal Cord Surgery, Fujita Health University, Toyoake.
⁵ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

The authors report the first cases of fluorescence-guided spinal surgery of schwannomas using near-infrared fluorescence imaging with the delayed window indocyanine (ICG) green (DWIG) technique for accurate real-time intraoperative tumor visualization. Patients with intradural spinal schwannomas received 0.5 mg/kg ICG at the beginning of surgery. After 1 hour, using the DWIG technique, near-infrared spectroscopy (NIRS) detected the spinal schwannomas, showing the exact tumor location and boundaries. DWIG with NIRS microscopy confirmed the exact location of spinal schwannomas before and after opening of the dura mater, thereby facilitating successful tumor dissection from the surrounding tissues, tumor resection, and confirmation of tumor removal. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21158.

Keywords: delayed window indocyanine green; near-infrared spectroscopy; spinal tumors.