gms | German Medical Science

Objective: Initial successful surgical treatment of pituitary adenomas is crucial to reach long-term remission. Indonyacine green videoangiography (ICG-VA) is established in vascular neurosurgery and some experience in brain tumor surgery was recently published. We designed this study to evaluate feasibility and outcome after transphenoidal resection of a pituitary lesion identified by intravenous application of ICG and visualisation via the fluorescence mode of the operation microscope.

Method: 21 patients with pituitary adenomas were treated with transphenoidal microsurgery and were included in this study. All patients had to consent to the surgical procedure after careful discussion of possible risks, benefits and alternatives. Intraoperatively 25 mg ICG was administered intravenously and visualized via the fluorescence mode of the operation microscope (Pentero / Zeiss).

Results: In 20 of 21 patients qualifying for transphenoidal surgery a lesion could be identified in preoperative MR-imaging (mean diameter: 8.95 mm; SD 3.4) (6 macroadenomas, 14 microadenomas, one MR-negative). 14 patients presented with acromegaly, 5 with M. Cushing and 2 with other symptoms (vision disorder, dizziness). In all 21 patients ICG-VA was performed during surgery. No technical failures or adverse events after drug administration occurred. In all patients the adenoma could be detected. Postoperative MR showed sufficient resection results without evidence of residual tumor tissue in 20 patients (in one patient with a MR-negative lesion no postoperative MR was performed). In those patients with initially high IGF levels postoperative analysis of IGF revealed significant reduction with mean postoperative IGF levels of 238.1 ng/ml (SD 68.8). In all patients suffering from M. Cushing postoperative urinary cortisol levels normalized. Follow-up was accomplished in 20 of 21 patients (95.2%) after 3 to 78 months (mean: 12.9 months, SD: 17.2) consisting of MRI and / or endocrinological evaluation. In one case a recurrence of the tumor was diagnosed after 24 months and a re-resection was performed. Overall recurrence rate during follow-up was 5%.

Conclusions: For the first time, our study presents outcome data of patients which underwent transphenoidal surgery of a pituitary lesion identified via intraoperative ICG application. We conclude that ICG-VA can help to opitimize postoperative outcome of patients with pituitary adenoma. A study including a larger sample size and comparison to results of a control group is needed.