Abstract
In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to safely resect tumors located in the narrow parapharyngeal space, indocyanine green (ICG) fluorescence imaging for navigation surgery is proposed recently. In the following case study, the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumors has been demonstrated. Initially, 0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was conducted with HEMS (Hyper Eye Medical System) between 5 and 30 min after the initial injection. At first, the position of the tumor was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. The submucosal tumor obscured fascia was confirmed under HEMS imaging and then resected completely. As a result, all tumors displayed bright fluorescence emissions that contrasted clearly with the surrounding normal structures. Even with the submucosal tumor covered with and obscured by fascia, the tumor could be clearly observed under HEMS imaging. Tumors located behind the carotid artery and lower cranial nerves also displayed bright fluorescent emissions and could be clearly detected. As a result, the tumor could be completely resected safely and noninvasively to preserve pharyngeal functions. In conclusion, ICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumors while preserving functions.
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References
Carrau RL, Myers E, Johnson J. Management of tumors arising in the parapharyngeal space. Laryngoscope. 1990;100:583–9.
Desai SC, Sung CK, Genden EM. Transoral robotic surgery using an image guidance system. Laryngoscope. 2008;118:2187–9.
Yokoyama J, Ooba S, Fujimaki M, et al. Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumors. J cranio-maxillofacial Surg. 2014;42:835–8.
Fujimaki M, Yokoyama J, Ohba S, et al. Dynamic imaging in determining the optimum surgical time for NIR fluorescent image-guided surgery. Head Neck Oncol. 2012;4:50.
Poellinger A, Burock S, Grosenick D, et al. Breast Cancer: early- and late-fluorescence near-infrared imaging with indocyanine green-a preliminary study. Radiology. 2011;258:409–16.
Yokoyama J, Ohba S. ICG fluorescent image-guided surgery in head and neck cancer. In: Kusano M, Kokudo N, Toi M, Kaibori M, editors. ICG fluorescence imaging and navigation surgery. Tokyo: Springer; 2016. p. 49–62.
Ishizawa T, Fukushima N, Shibahara J, Masuda K, Tamura S, Aoki T, Hasegawa K, Beck Y, Fukayama M, Kokudo N. Real-time identification of liver cancers by using indocyanine green fluorescent imaging. Cancer. 2009;115:2491–504.
Yokoyama J, Ito S, Ohba S, Fujimaki M, Ikeda K. A novel approach to translymphatic chemotherapy targeting sentinel lymph nodes of patients with oral cancer using intra-arterial chemotherapy. Head Neck Oncol. 2011;3:42.
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This video shows transoral resection of parapharyngeal space metastasis from hypopharyngeal cancer with guiding ICG imaging. Confirming the submucosal tumor obscured fascia clearly under ICG imaging with color imaging, we could then safely remove the tumor, preventing damage to the carotid artery and lower cranial nerves. (WMV 17204 kb)
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Yokoyama, J., Ohba, S. (2020). Parapharyngeal Space Tumors. In: Aleassa, E., El-Hayek, K. (eds) Video Atlas of Intraoperative Applications of Near Infrared Fluorescence Imaging. Springer, Cham. https://doi.org/10.1007/978-3-030-38092-2_30
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DOI: https://doi.org/10.1007/978-3-030-38092-2_30
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