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Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach

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Abstract

Purpose

Initial successful surgical treatment of pituitary adenomas is crucial to reach long-term remission. Indocyanine green (ICG) videoangiography (VA) is well established in vascular neurosurgery nowadays and several reports described ICG application in brain tumor surgery. We designed this study to evaluate the feasibility of intravenous application of ICG and visualisation of a pituitary lesion via the fluorescence mode of the operation microscope.

Methods

22 patients with pituitary adenomas were treated with transsphenoidal microsurgery and were included in this study. Intraoperatively 25 mg ICG was administered intravenously and visualized via the fluorescence mode of the operation microscope (Pentero/Zeiss).

Results

22 patients qualified for transsphenoidal surgery presenting with different clinical symptoms (13 patients with acromegaly, 6 with M. Cushing and 3 with other symptoms like vision disorder or dizziness) and identification of a pituitary lesion (21 of 22 patients) in preoperative MR-imaging (mean diameter: 9 mm; SD 3.6; 6 macroadenomas, 15 microadenomas, 1 MR-negative). In all 22 patients ICG VA was performed during surgery. No technical failures or adverse events after drug administration occurred. Visualization was optimal approximately 2.4 min after intravenous application. In all patients the adenoma could be detected via two different types of visualization: direct visualization by fluorophore emission versus indirect detection of the adenoma by a lower ICG fluorescence compared to the surrounding tissue.

Conclusion

Our data show that intraoperative ICG VA can be a useful and easily applicable additional diagnostic tool for visualization of pituitary lesions using the microscopic approach.

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Acknowledgments

The authors are grateful to Mr. Manfred Eifler-Sander for clinical patient management and documentation.

Conflict of interest

All of the authors are aware of and agree to the content of the manuscript and their being listed as an author on the manuscript. None of the authors has any financial interest in this work.

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Authors and Affiliations

  1. Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    N. Sandow, W. Klene & P. Vajkoczy

  2. Department of Endocrinology, Diabetes and Nutritional Medicine, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany

    U. Elbelt & C. J. Strasburger

Authors
  1. N. Sandow
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  2. W. Klene
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  3. U. Elbelt
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  4. C. J. Strasburger
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  5. P. Vajkoczy
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Corresponding author

Correspondence to P. Vajkoczy.

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Sandow, N., Klene, W., Elbelt, U. et al. Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach. Pituitary 18, 613–620 (2015). https://doi.org/10.1007/s11102-014-0620-7

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  • DOI: https://doi.org/10.1007/s11102-014-0620-7

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