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Fluorescence guided surgery for pituitary adenomas

Abstract

Purpose

Resection of pituitary adenomas presents a number of unique challenges in neuro-oncology. The proximity of these lesions to key vascular and endocrine structures as well as the need to interpret neuronavigation in the context of shifting tumor position increases the complexity of the operation. More recently, substantial advances in fluorescence-guided surgery have been demonstrated to facilitate the identification of numerous tumor types and result in increased rates of complete resection and overall survival.

Methods

A review of the literature was performed, and data regarding the mechanism of the fluorescence agents, their administration, and intraoperative tumor visualization were extracted. Both in vitro and in vivo studies were assessed. The application of these agents to pituitary tumors, their advantages and limitations, as well as future directions are presented here.

Results

Numerous laboratory and clinical studies have described the use of 5-ALA, fluorescein, indocyanine green, and OTL38 in pituitary lesions. All of these drugs have been demonstrated to accumulate in tumor cells. Several studies have reported the successful use of the majority of the agents in inducing intraoperative tumor fluorescence. However, their sensitivity and specificity varies across the literature and between functioning and non-functioning adenomas.

Conclusions

At present, numerous studies have shown the feasibility and safety of these agents for pituitary adenomas. However, further research is needed to assess the applicability of fluorescence-guided surgery across different tumor subtypes as well as explore the relationship between their use and postoperative clinical outcomes.

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Fig. 1

(with permission from Hadjipanayis et al. [25])

Fig. 2

(with permission from Cho et al. [28])

Fig. 3

(with permission from Cho et al. [28])

Fig. 4

(with permission from Falco et al. [35]

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Correspondence to Constantinos G. Hadjipanayis.

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Constantinos Hadjipanayis is a consultant for NXDC and Synaptive Medical Inc. He will receive royalties from NXDC. He has also received speaker fees by Carl Zeiss and Leica.

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Lakomkin, N., Van Gompel, J.J., Post, K.D. et al. Fluorescence guided surgery for pituitary adenomas. J Neurooncol 151, 403–413 (2021). https://doi.org/10.1007/s11060-020-03420-z

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  • DOI: https://doi.org/10.1007/s11060-020-03420-z

Keywords

  • ICG
  • Fluorescein
  • 5-ALA
  • Resection
  • Brain tumor
  • Outcomes