Teng Clare W, Huang Vincent, Arguelles Gabriel R, Zhou Cecilia, Cho Steve S, Harmsen Stefan, Lee John Y K
1Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia; and.
2Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Neurosurg Focus. 2021 Jan;50(1):E4. doi: 10.3171/2020.10.FOCUS20782.
Indocyanine green (ICG) is a water-soluble dye that was approved by the FDA for biomedical purposes in 1956. Initially used to measure cardiocirculatory and hepatic functions, ICG's fluorescent properties in the near-infrared (NIR) spectrum soon led to its application in ophthalmic angiography. In the early 2000s, ICG was formally introduced in neurosurgery as an angiographic tool. In 2016, the authors' group pioneered a novel technique with ICG named second-window ICG (SWIG), which involves infusion of a high dose of ICG (5.0 mg/kg) in patients 24 hours prior to surgery. To date, applications of SWIG have been reported in patients with high-grade gliomas, meningiomas, brain metastases, pituitary adenomas, craniopharyngiomas, chordomas, and pinealomas.The applications of ICG have clearly expanded rapidly across different specialties since its initial development. As an NIR fluorophore, ICG has advantages over other FDA-approved fluorophores, all of which are currently in the visible-light spectrum, because of NIR fluorescence's increased tissue penetration and decreased autofluorescence. Recently, interest in the latest applications of ICG in brain tumor surgery has grown beyond its role as an NIR fluorophore, extending into shortwave infrared imaging and integration into nanotechnology. This review aims to summarize reported clinical studies on ICG fluorescence-guided surgery of intracranial tumors, as well as to provide an overview of the literature on emerging technologies related to the utility of ICG in neuro-oncological surgeries, including the following aspects: 1) ICG fluorescence in the NIR-II window; 2) ICG for photoacoustic imaging; and 3) ICG nanoparticles for combined diagnostic imaging and therapy (theranostic) applications.
吲哚菁绿（ICG）是一种水溶性染料，于1956年获美国食品药品监督管理局（FDA）批准用于生物医学目的。ICG最初用于测量心脏循环和肝功能，其在近红外（NIR）光谱中的荧光特性很快使其应用于眼科血管造影。21世纪初，ICG作为一种血管造影工具正式引入神经外科。2016年，作者团队开创了一种使用ICG的新技术，名为第二窗口ICG（SWIG），该技术涉及在手术前24小时给患者输注高剂量的ICG（5.0mg/kg）。迄今为止，SWIG已在高级别胶质瘤、脑膜瘤、脑转移瘤、垂体腺瘤、颅咽管瘤、脊索瘤和松果体瘤患者中得到应用。自最初开发以来，ICG的应用显然已在不同专业迅速扩展。作为一种近红外荧光团，ICG比其他所有目前处于可见光光谱的FDA批准的荧光团具有优势，因为近红外荧光具有更强的组织穿透性和更低的自发荧光。最近，人们对ICG在脑肿瘤手术中的最新应用的兴趣已超出其作为近红外荧光团的作用，扩展到短波红外成像以及与纳米技术的整合。本综述旨在总结关于ICG荧光引导下颅内肿瘤手术的已报道临床研究，并概述与ICG在神经肿瘤手术中的应用相关的新兴技术文献，包括以下方面：1）近红外二区窗口中的ICG荧光；2）用于光声成像的ICG；3）用于联合诊断成像和治疗（诊疗）应用的ICG纳米颗粒。
