Feasibility of real-time intraoperative fluorescence imaging of dural sinus thrombosis

Dural sinus thrombosis is a well-recognized and potentially serious complication following lateral skull base surgery. Methods of diagnosis are limited to post-operative computerized tomography scans or magnetic resonance venography. There are currently no reports of an intraoperative technique used to detect dural sinus thrombosis. Here, we describe the case of a 62-year-old woman who underwent translabyrinthine resection of a right vestibular schwannoma with no evidence of sinus thrombosis on pre-operative scans. Following tumor resection, patency of the sigmoid sinus was assessed intraoperatively using indocyanine green (ICG) videography which revealed a lack of flow in the right sigmoid sinus. Postoperative CT scan confirmed thrombosis of the right sigmoid sinus. We present the first report of real-time intraoperative diagnosis of sigmoid sinus thrombosis during removal of a vestibular schwannoma. ICG videography may be used for intraoperative visualization of dural sinus integrity and patency during prolonged or technically challenging microsurgical procedures. This technique may enable periodic monitoring and early identification of filling defects which can guide further intraoperative strategies and postoperative monitoring.