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Object: Indocyanine green (ICG) videography is commonly used in the neurosurgical field for minimally invasive neurosurgery. The aim of this study was to evaluate a new intraoperative imaging modality by performing transdural ICG videography during surgery for meningiomas., Methods: Between March 2011 and April 2012, 10 patients with meningiomas received intravenous injection of 12.5 mg ICG just prior to dural opening. The cases comprised 8 convexity meningiomas and 2 foramen magnum meningiomas. Efficacy of the transdural ICG videography was assessed in terms of the tumor volume, the circulation time from the first appearance of the vessel to the appearance of the venous sinus, the tendency to bleed, and the discrimination of the venous sinus., Results: The mean tumor volume was 71.6 ± 87.9 ml (the mean is expressed ± SD throughout). The cortical arteries, veins, and the venous sinus were identified by the ICG videography transdurally. The projection of the meningiomas was identified by a shadow (which the authors call the eclipse sign). Total eclipse signs were obtained in 8 cases and partial eclipse signs were obtained in 2 cases; tumor volume in the latter was more than 200 ml. In 5 of 10 cases the adjacent venous sinuses were exposed and were successfully visualized by ICG videography in 5.92 ± 1.05 seconds from the first appearance of the vessel. In 5 of 10 cases the total and the partial eclipse signs were diminished in 3.46 ± 1.31 seconds. The diminishment of the total and the partial eclipse sign was earlier than the visualization of the venous sinus (p = 0.011, t-test), revealing bleeding from the tumor that was observed until coagulation of the feeding arteries from the intracranial arteries., Conclusions: Prior to opening of the dura mater, transdural ICG videography was used successfully to visualize the dural attachment of meningiomas and the venous sinus, resulting in safe and appropriate dural opening. The diminishment of the total and partial eclipse signs may represent significant feeding from the intracranial arteries and a tendency to bleed during resection.

Background: Indocyanine green videography has been introduced into neurosurgical fields for minimally invasive neurosurgery. To establish a new intraoperative imaging modality, we performed transdural indocyanine green videography during the surgery of meningiomas., Method: A dose of 12.5 mg of indocyanine green was injected transvenously in two cases of meningiomas just before the dural opening. Transdural indocyanine green videography was monitored., Results: The cortical arteries and veins and the venous sinus were identified by the indocyanine green videography transdurally in both cases. The projection of meningiomas was identified as the shadow and signal negative regions, and was visualized as "the Eclipse.", Conclusion: Transdural observation of the cortical arteries and veins and the venous sinus was successfully performed followed by the visualization of the projection of meningiomas as the shadow. We propose this sign as "the Eclipse sign." This transdural imaging method was of value in terms of precise and minimal dural incision., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: The most relevant factor in the progression-free survival (PFS) of patients with meningiomas is the malignant grade. However, using only the current World Health Organization (WHO) definition that does not consider precise quantitative indicators, an unequivocal diagnosis of the malignant grade is difficult. In our retrospective study of the PFS of meningioma patients, we focused on mitoses and the Ki-67 staining index of tumor specimens obtained at the initial surgery., Methods and Results: A total of 349 patients with intracranial meningioma, operated between 1978 and 2000, were followed for a mean of 7 years. According to the mitotic index (MI), we classified them into 3 groups. In Group A (n = 326), slide-mounted tumor samples exhibited no mitoses; in Group B (n = 15) there were fewer than 4 mitoses, and in Group C (n = 8) 4 or more mitoses were seen per 10 high-power fields (HPF). The estimated 5-year PFS rates in Groups A, B, and C were 93%, 10%, and 13% respectively. The mean PFS for Group A was 148 months; in Groups B and C the median PFS was 43 and 16 months, respectively. A Ki-67 staining index (SI) of less than 1% corresponded with no mitosis, while an SI exceeding 5% was indicative of the presence of mitoses., Conclusion: In meningioma patients, no mitoses and/or a Ki-67 SI <1% signals a favorable outcome. An SI >5% or the presence of mitoses, even fewer than 4 in 10 HPF, is suggestive of a short PFS irrespective of other pathologic features. We suggest that in combination, assay of the Ki-67 SI and the MI represents a reliable, quantitative tool for predicting PFS in meningioma patients.

We examined the expression of fibroblast growth factor receptor-1 (FGFR-1), namely FLG, in tissues of 18 human gliomas, 10 human meningiomas, 3 human metastatic brain tumors, and 2 normal human brains by means of immunohistochemistry. All tissues were positively stained for FGFR-1. Primary brain tumors were more abundantly immunoreactive than normal brain tissues (Mann-Whitney U test, P < 0.05). There was significant correlation between the expression level of basic fibroblast growth factor (basic FGF) and that of FGFR-1 in tissues of human glioma (Spearman's test, P < 0.05). The expression level of FGFR-1 of tumor cells increased in correlation with that of endothelial cells in glioma tissues (Spearman's test, P < 0.001). We previously reported that basic FGF is produced in more than 90% of human glioma and meningioma tissues. Together with these data, it is suggested that basic FGF is involved in autonomous cell growth and tumorigenesis of gliomas and meningiomas as an autocrine growth factor in vivo.