Article
Clinical use of indocyanine green fluorescence endoscopy in endonasal transsphenoidal surgery
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Authors
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Dirk Lindner
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
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Mathias Hofer
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Leipzig, Deutschland
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Jürgen Meixensberger
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Neurochirurgie, Leipzig, Deutschland
| Published: | June 18, 2018 |
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Outline
Text
Objective: Today endoscopic assisted surgery is a standard procedure for transnasal transsphenoidal surgery. Intraoperative identification of typical landmarks in sellar and pituitary surgery is necessary for optimal tumor removal.
The aim of this preliminary clinical study is the intraoperative use of indocyanine green fluorescence endoscopy for
- 1.
- Visualization of surrounding vascular structures,
- 2.
- Investigation of vascularization of dura and tumor capsule and
- 3.
- Differentiation between sellar tumor and pituitary gland.
Methods: This prospective clinical study was approved by the local ethics committee. 17 patients (13 males and 4 females) were included since November 2016 suffering on non-active pituitary macroadenoma (n=8), hormone-active adenoma (n=8) and one mucocele with sellar enlargement.
Rigid 0° and 30° endoscopes (4mm in diameter, Fa. Karl Storz) are commonly used for endoscopic surgery. For ICG-fluorescence a different endoscope (5,8mm in diameter) with a 0° telescope was used. For endoscopic-based fluorescence 12,5-25mg ICG was injected when the sellar dura was exposed. A second injection was possible after tumor removal.
Results: Only in one patient the ICG-videoangiography was technical incorrect because of a defect of the light fiber cable. The quality of the first fluorescent examination was at the very beginning limited by blood in the sphenoidal sinus (three patients). With improvement of the local coagulation, we reached a good and very good video quality in the remaining 14 patients with high-resolution of internal carotid artery (ICA), intercavernous (ICS) and cavernous sinus (CS). Investigation of vascular structures in the sellar dura and tumor capsule were easily accessible in all 16 patients. During tumor removal, a differentiation between pituitary gland and tumor based on ICG was achieved in only 3 patients (19%). In three patients, pituitary stalk and chiasm was visualized with ICG after tumor removal.
Conclusion: Indocyanine green fluorescence endoscopy offer an anatomical update of vascular structures (ICA, ICS, CS) before tumor resection. This is a promising result of this preliminary study. The visualization of vascular pattern of the sellar dura can optimized the approach to the tumor and minimize the risk of bleeding. Future research areas are technical developments in the endoscope, different administration protocols and perfusion analysis.
