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Indocyanine green endoscopic evaluation of pituitary stalk and gland blood flow in craniopharyngiomas

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Abstract

To assess the use of indocyanine green (ICG) fluorescence endoscopy to evaluate pituitary blood flow in craniopharyngioma resection and its possible impact on intraoperative decisions regarding pituitary stalk processing. Patients with craniopharyngiomas who had undergone transsphenoidal surgery since March 2021, when an ICG endoscope was introduced at the Kagoshima University Hospital, were included in the study. When targeted tumor removal was approaching completion, 10 mg of ICG was administered intravenously to evaluate blood flow in the pituitary stalk and gland. ICG signals and endocrinological status before and after surgery were evaluated retrospectively. Pituitary stalk and gland blood flow were evaluated as positive (++), weakly positive (+), and no signal (−).Ten patients with craniopharyngiomas underwent transsphenoidal surgery using an ICG endoscope (mean age 56.6 ± 14.2 years; 40% male). Among the eight patients in whom the pituitary stalk was preserved, pituitary function with positive signal on the stalk was intact in two. Two other patients with weakly positive stalk and positive pituitary gland signals showed intact function or minimal pituitary dysfunction. Four patients had impairments in more than three axes with poor ICG signals in the stalk or pituitary gland. Two patients underwent pituitary amputation because of high tumor invasion and lack of ICG signal in the stalk after tumor removal, resulting in panhypopituitarism. A negative ICG signal in the pituitary stalk is likely to indicate postoperative pituitary function loss. Craniopharyngioma surgery using ICG endoscopy may be useful for predicting endocrine prognosis and improving tumor outcomes.

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Data availability

The datasets are not publicly available but are available from the corresponding author upon reasonable request.

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Acknowledgments

We would like to thank Editage for the editorial assistance.

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None.

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Authors and Affiliations

  1. Department of Neurosurgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan

    Ryutaro Makino, Shingo Fujio, Jun Sugata, Masanori Yonenaga, Tomoko Hanada, Nayuta Higa, Hitoshi Yamahata & Ryosuke Hanaya

  2. Pituitary Disorders Center, Kagoshima University Hospital, Kagoshima, Japan

    Ryutaro Makino, Shingo Fujio, Jun Sugata & Tomoko Hanada

Authors
  1. Ryutaro Makino
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  2. Shingo Fujio
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  3. Jun Sugata
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  4. Masanori Yonenaga
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  5. Tomoko Hanada
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  6. Nayuta Higa
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  7. Hitoshi Yamahata
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  8. Ryosuke Hanaya
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Contributions

Conception and design: R.M., S.F., and R.H. Acquisition of data (e.g., patient acquisition and management): R.M, J.S., M.Y., T.H., N.H., and H.Y. Analysis and interpretation of data: R.M. Manuscript writing, and revision: R.M., S.F., and R.H. Administrative or technical support (e.g., database building and organization): R.M., S.F, and R.H. Study supervision: R.M., S.F., J.S., M.Y., T.H., N.H., and H.Y.

Corresponding author

Correspondence to Shingo Fujio.

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Ethics approval

This study was approved by the Kagoshima University Hospital Ethics Committee (reference no. 220186). Study-specific informed consent was obtained from all patients. An opt-out approach was used for past samples.

Competing interests

The authors declare no competing interests.

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Makino, R., Fujio, S., Sugata, J. et al. Indocyanine green endoscopic evaluation of pituitary stalk and gland blood flow in craniopharyngiomas. Neurosurg Rev 46, 312 (2023). https://doi.org/10.1007/s10143-023-02223-w

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  • DOI: https://doi.org/10.1007/s10143-023-02223-w

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