The role of indocyanine green fluorescence in endoscopic endonasal skull base surgery and its imaging correlations

Author:

Shahein Mostafa12,Prevedello Daniel M.13,Beaumont Thomas L.1,Ismail Khalid2,Nouby Radwan2,Palettas Marilly4,Prevedello Luciano M.5,Otto Bradley A.13,Carrau Ricardo L.13

Affiliation:

1. Departments of Neurological Surgery,

2. Department of Neurosurgery, Aswan University Hospitals, Aswan University, Aswan, Egypt

3. Otolaryngology–Head and Neck Surgery,

4. Biomedical Informatics—Center for Biostatistics, and

5. Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio; and

Abstract

OBJECTIVE The use of endoscope-integrated indocyanine green (E-ICG) has recently been introduced in skull base surgery. The quantitative correlation between E-ICG and T1-weighted gadolinium-enhanced (T1WGd) images for skull base tumors has not been previously assessed, to the authors’ knowledge. In this study, the authors investigated the indications for use and the limitations of E-ICG and sought to correlate the endoscopic fluorescence pattern with MRI contrast enhancement. METHODS Following IRB approval, 20 patients undergoing endoscopic endonasal skull base surgery between June 2017 and August 2018 were enrolled in the study. Tumor fluorescence was measured using a blue color value and blood fluorescence as a control. Signal intensities (SIs) of tumor T1WGd images were measured and the internal carotid artery (ICA) SI was used as a control. For pituitary adenoma, the pituitary gland fluorescence was also measured. The relationships between ICG fluorescence and MRI enhancement measurements were analyzed. RESULTS Data showed that in pituitary adenoma there was a strong correlation between the ratios of gland/blood fluorescence to gland/ICA SI (n = 8; r = 0.92; p = 0.001) and tumor/blood fluorescence to tumor/ICA SI (n = 9; r = 0.82; p = 0.006). In other pathologies there was a strong correlation between the ratios of tumor/blood fluorescence and tumor/ICA SI (n = 9; r = 0.74; p = 0.022). The ICG fluorescence allowed perfusion assessment of the pituitary gland as well as of the nasoseptal flaps. Visualization of the surrounding vasculature was also feasible. CONCLUSIONS Defining the indications and understanding the limitations are critical for the effective use of E-ICG. Tumor fluorescence seems to correlate with preoperative MRI contrast enhancement.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

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