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

Shahein, Mostafa; Prevedello, Daniel M.; Beaumont, Thomas L.; Ismail, Khalid Ahmed; Nouby, Radwan; Palettas, Marilly; Prevedello, Luciano M.; Otto, Bradley A.; Carrau, Ricardo L.

doi:10.3171/2020.6.jns192775

Cited by 4 publications

(2 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More recently, Shahein et al tried to define indications and limitations for the use of ICG based on previous experience and their own experiences with 10 PA cases. In particular, they were the first to systematically correlate MRI images with intraoperative ICG fluorescence, postulating that the various patterns of enhancement seen in MRI are due to the differences between the vascular features of the gland and the tumor [ 22 ]. Starting from these assumptions, they indicated that both the presentation to the sellar surface, the presence of an intact pseudocapsule, and intratumoral bleeding were the main factors that should be considered when selecting cases.…”

Section: Resultsmentioning

confidence: 99%

Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal

et al. 2021

View full text Add to dashboard Cite

(1) Background: Despite many surgical and technological advances, pituitary adenoma surgery is still burdened by non-negligible rates of incomplete tumor resection, mainly due to difficulties in differentiating pathology from normal pituitary tissue. Some fluorescent agents have been recently investigated as intraoperative contrast agents in pituitary surgery. The aim of this study is to evaluate the actual knowledge about the usefulness of such fluorophores with a particular focus on both the pharmacokinetics and pharmacodynamics issues of the pituitary gland. (2) Methods: We reviewed the current literature about fluorophores use in pituitary surgery and reported the first fully endoscopic experience with fluorescein. (3) Results: The studies investigating 5-ALA use reported contrasting results. ICG showed encouraging results, although with some specificity issues in identifying pathological tissue. Low-dose fluorescein showed promising results in differentiating pathology from normal pituitary tissue. Apart from the dose and timing of administration, both the fluorophores’ volume of distribution and the histological variability of the interstitial space and vascular density played a crucial role in optimizing intraoperative contrast enhancement. (4) Conclusions: Both pharmacokinetics and pharmacodynamics issues determine the potential usefulness of fluorophores in pituitary surgery. ICG and fluorescein showed the most promising results, although further studies are needed.

show abstract

Section: Resultsmentioning

confidence: 99%

Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal

et al. 2021

View full text Add to dashboard Cite

show abstract

“…18 In skull base reconstruction, ICG angiography has been employed in several highvolume centers for the same purposes. [19][20][21][22]…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review

Shaikh

O’Brien

Makary

et al. 2021

J Neurol Surg B Skull Base

View full text Add to dashboard Cite

Objective This study was aimed to study the current use of intraoperative indocyanine green (ICG) angiography during skull base reconstruction and understand its efficacy in predicting postoperative magnetic resonance imaging (MRI) enhancement and flap. Study Design The Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar databases were searched from the date of inception until August 2020 for studies of ICG flap perfusion assessment during skull base reconstruction. The primary outcome of interest was the development of cerebrospinal fluid (CSF) leak after skull base reconstruction. Secondary outcomes of interest included postoperative meningitis, flap MRI enhancement, flap necrosis, flap perfusion measurements, and total complications. Results Search results yielded 189 studies, from which seven studies with a total of 104 patients were included in the final analysis. There were 44 nasoseptal flaps (NSF), two lateral nasal wall flaps (LNWF), 14 pericranial flaps (PCF), and 44 microvascular free flaps. The rates of CSF leak and postoperative MRI enhancement were 11 and 94%, respectively. There was one case of postoperative meningitis. Pooled analysis of the available data showed that intraoperative ICG flap perfusion was associated with flap enhancement on postoperative MRI (p = 0.008) and CSF leak (p = 0.315) by Fisher's exact test. Conclusion The available literature suggests intraoperative ICG enhancement is associated with postoperative MRI enhancement. Given the small sample sizes in the literature and the rarity of complications associated with skull base reconstruction, intraoperative ICG enhancement has not been predictive of flap necrosis or postoperative complications such as CSF leak or meningitis. Level of Evidence This study presents level 3 evidence as a systematic review of case studies, case reports, and retrospective and prospective trials with no blinding, controls, and inconsistently applied reference standards.

show abstract

Fluorescent Imaging In Vivo

Demchenko

2023

Introduction to Fluorescence Sensing

View full text Add to dashboard Cite

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

Cited by 4 publications

References 33 publications

Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal

Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal

Intraoperative Indocyanine Green Angiography for Assessing Flap Perfusion in Skull Base Reconstruction: A Systematic Review

Fluorescent Imaging In Vivo

Contact Info

Product

Resources

About