Department of Neurosurgery, George Washington University, Washington DC 20037, USA.
J Neurosurg. 2012 May;116(5):935-41. doi: 10.3171/2012.1.JNS11601. Epub 2012 Feb 24.
As demonstrated by histological and neuroimaging studies, pituitary adenomas have a capillary vascular density that differs significantly from that of surrounding structures. The authors hypothesized that intraoperative indocyanine green (ICG) fluorescence endoscopy could be used to visually differentiate tumor from surrounding tissues, including normal pituitary gland and dura.
After institutional review board approval, 16 patients undergoing endoscopic transsphenoidal surgery for benign pituitary lesions were prospectively enrolled in the study. A standard endoscopic endonasal approach to the sella was completed. Each patient then underwent endoscopic examination of the sellar dura and then the exposed pituitary adenoma after ICG bolus injection (12.5-25 mg). This examination was performed using a custom endoscope with a near-infrared light source and excitation wavelength filter.
The authors successfully recorded ICG fluorescence from sellar dura, pituitary, and surrounding structures in 12 of 16 patients enrolled. There were 3 technical failures of intraoperative ICG endoscopy, and 1 patient was excluded following discovery of a dye cross-allergy. A standard dose of 25 mg of ICG in 10 ml of aqueous solution optimized visualization of sellar region microvasculature within 45 seconds of peripheral bolus injection. Adenoma was less fluorescent than normal pituitary gland. Dural invasion by tumor was identifiable by a marked increase in fluorescence compared with native dura. The ICG endoscopic examination added 15-20 minutes of operative time under general anesthesia. There were no complications that resulted from use of ICG or the fluorescent light source.
Indocyanine green fluorescence endoscopy shows promise as an intraoperative modality to visually distinguish pituitary tumors from normal tissue and to visually identify areas of dural invasion, thereby facilitating complete tumor resection and minimizing injury to surrounding structures. These results support the continued development of fluorescence endoscopic resection techniques.
组织学和神经影像学研究表明，垂体腺瘤的毛细血管密度与周围结构有显著差异。作者假设术中吲哚菁绿（ICG）荧光内镜检查可用于从周围组织（包括正常垂体和硬脑膜）中肉眼区分肿瘤。
在机构审查委员会批准后，前瞻性纳入 16 例接受内镜经蝶窦手术治疗良性垂体病变的患者进行研究。完成标准的内镜经鼻入路蝶鞍。然后，每位患者在 ICG 推注（12.5-25mg）后，行内镜检查鞍底硬脑膜，然后暴露垂体腺瘤。该检查使用带近红外光源和激发波长滤波器的定制内镜进行。
作者成功记录了 16 例患者中的 12 例蝶鞍硬脑膜、垂体和周围结构的 ICG 荧光。术中 ICG 内镜检查有 3 次技术失败，1 例因发现染料交叉过敏而被排除。在周围推注后 45 秒内，用 10ml 水溶液中的标准剂量 25mgICG 可优化观察鞍区微血管。与正常垂体相比，腺瘤的荧光强度较低。与正常硬脑膜相比，肿瘤对硬脑膜的侵犯可通过荧光强度的明显增加来识别。ICG 内镜检查在全身麻醉下增加了 15-20 分钟的手术时间。没有因使用 ICG 或荧光光源而导致的并发症。
吲哚菁绿荧光内镜检查有望成为一种术中方法，用于从正常组织中肉眼区分垂体肿瘤，并识别硬脑膜侵犯区域，从而促进肿瘤的完全切除，最大限度地减少对周围结构的损伤。这些结果支持荧光内镜切除技术的进一步发展。
