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Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors

  • Original Article - Pituitaries
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Abstract

Background

For the precise removal of pituitary tumors, preserving the surrounding normal structures, we need real-time intraoperative information on tumor location, margins, and surrounding structures. The aim of this study was to evaluate the benefits of a new intraoperative real-time imaging modality using indocyanine green (ICG) fluorescence through an endoscopic system during transsphenoidal surgery (TSS) for pituitary tumors.

Methods

Between August 2013 and October 2014, 20 patients with pituitary and parasellar region tumors underwent TSS using the ICG fluorescence endoscopic system. We used a peripheral vein bolus dose of 6.25 mg/injection of ICG, started with a time counter, and examined how each tissue type increased and decreased in fluorescence through time.

Results

A total of 33 investigations were performed for 20 patients: 9 had growth hormone secreting adenomas, 6 non-functioning pituitary adenomas, 3 Rathke’s cleft cysts, 1 meningioma, and 1 pituicytoma. After the injection of ICG, the intensity of fluorescence of tumor and normal tissues under near-infrared light showed clear differences. We could differentiate tumor margins from adjacent normal tissues and define clearly the surrounding normal structures using the different fluorescent intensities time changes and tissue-specific fluorescence patterns.

Conclusions

The ICG endoscopic system is simple, user-friendly, quick, cost-effective, and reliable. The method offered real-time information during TSS to delimit pituitary and parasellar region tumor tissue from surrounding normal structures. This method can contribute to the improvement of total removal rates of tumors, reduction of complications after TSS, saving surgical time, and preserving endocrinological functions.

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Abbreviations

CS:

Cavernous sinus

CT:

Computed tomography

GHoma:

Growth hormone-producing pituitary adenoma

ICG:

Indocyanine green

ICS:

Intercavernous sinus

MRI:

Magnetic resonance image

NFoma:

Non-functioning pituitary adenoma

RCC:

Rathke’s cleft cysts

TSS:

Transsphenoidal surgery

T1WIGd:

T1-weighted image with gadolinium enhancement

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Acknowledgements

We would like to thank Kostadin L. Karagiozov, MD, PhD, for his review of this manuscript and Ichiro Fujisawa, radiologist, for the advice on MRI of pituitary adenoma.

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Authors and Affiliations

  1. Department of Neurosurgery, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan

    Kosaku Amano, Yasuo Aihara, Shunsuke Tsuzuki, Yoshikazu Okada & Takakazu Kawamata

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  1. Kosaku Amano
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  2. Yasuo Aihara
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  3. Shunsuke Tsuzuki
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  4. Yoshikazu Okada
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  5. Takakazu Kawamata
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Correspondence to Kosaku Amano.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Amano, K., Aihara, Y., Tsuzuki, S. et al. Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors. Acta Neurochir 161, 695–706 (2019). https://doi.org/10.1007/s00701-018-03778-0

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