Use of Neuronavigation System for Superficial Vein Identification: Safe and Quick Method to Avoid Intraoperative Bleeding and Vein Closure: Technical Note

Background: Contributions on using navigation in neurosurgery have been shared widely. However, few authors have reported their experience identifying superficial vessels before dural opening using indocyanine green–video angiography. Furthermore, this technique has shown some limitations. Methods: For many years, each time we planned a needle biopsy for brain tumors, we set the entry point and trajectory on the navigator before surgery. Regarding the target, we systematically chose both a trajectory, which should avoid any crossing with vessels, and an entry far from veins or granulations. Gadolinium-enhanced magnetic resonance imaging T1-weighted sequences have been demonstrated to be adequate for this purpose. Note that we used the Medtronic StealthStation S8 (Minneapolis, Minnesota, USA) and gadolinium-enhanced magnetic resonance imaging T1-weighted sequences to plan 4 different surgical procedures (needle biopsy, parasagittal meningioma, double metastases, and high-grade glioma). Intraoperatively, after craniotomy and dural exposure, a Passive Planar Blunt Probe and dermographic pen were used to mark superficial vessels on the basis of navigational images. The dura was opened far from any marked line, vessels were dissected, and the dura was opened by a Penfield dissector and Metzenbaum scissors. Results: The mean planning time length was 7 minutes, and the marking procedure time length was 3 minutes. Dural marks perfectly corresponded to the underlying vessels. The correspondence rate of marks to underlying vessels was 100%. No one vessel unmarked was noticed. No superficial vessel injuries were reported. Conclusions: This technique provides a safe and fast method to avoid vessel injuries during dural opening. Furthermore, it could be useful as an educational tool.