Muto Jun, Mine Yutaka, Nishiyama Yuya, Murayama Kazuhiro, Yamada Seiji, Kojima Daijiro, Hayakawa Motoharu, Adachi Kazuhide, Hasegawa Mitsuhiro, Lee John Y K, Hirose Yuichi
Department of Neurosurgery, Fujita Health University, Toyoake, Japan.
Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
Front Neurosci. 2022 May 4;16:837349. doi: 10.3389/fnins.2022.837349. eCollection 2022.
Meningiomas are a common pathology in the central nervous system requiring complete surgical resection. However, in cases of recurrence and post-irradiation, accurate identification of tumor remnants and a dural tail under bright light remains challenging. We aimed to perform real-time intraoperative visualization of the meningioma and dural tail using a delayed-window indocyanine green (ICG) technique with microscopy. Fifteen patients with intracranial meningioma received 0.5 mg/kg ICG a few hours before observation during the surgery. We used near-infrared (NIR) fluorescence to identify the tumor location. NIR fluorescence could visualize meningiomas in 12 out of 15 cases. Near-infrared visualization during the surgery ranged from 1 to 4 h after the administration of ICG. The mean signal-to-background ratio (SBR) of the intracranial meningioma in delayed-window ICG (DWIG) was 3.3 ± 2.6. The ratio of gadolinium-enhanced T1 tumor signal to the brain (T1BR) (2.5 ± 0.9) was significantly correlated with the tumor SBR ( = 0.016). K , indicating blood-brain barrier permeability, was significantly correlated with tumor SBR ( < 0.0001) and T1BR ( = 0.013) on dynamic contrast-enhanced magnetic resonance imaging (MRI). DWIG demonstrated a sensitivity of 94%, specificity of 38%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 75% for meningiomas. This is the first pilot study in which DWIG fluorescence-guided surgery was used to visualize meningioma and dural tail intraoperatively with microscopy. DWIG is comparable with second-window ICG in terms of mean SBR. Gadolinium-enhanced T1 tumor signal may predict NIR fluorescence of the intracranial meningioma. Blood-brain barrier permeability as shown by K on dynamic contrast-enhanced MRI can contribute to gadolinium enhancement on MRI and to ICG retention and tumor fluorescence by NIR.
脑膜瘤是中枢神经系统的常见病变，需要进行完整的手术切除。然而，在复发和放疗后的病例中，在强光下准确识别肿瘤残余和硬脑膜尾征仍然具有挑战性。我们旨在使用延迟窗口吲哚菁绿（ICG）技术结合显微镜对脑膜瘤和硬脑膜尾征进行术中实时可视化。15例颅内脑膜瘤患者在手术观察前数小时接受了0.5mg/kg的ICG。我们使用近红外（NIR）荧光来确定肿瘤位置。NIR荧光在15例中的12例中可使脑膜瘤可视化。手术期间的近红外可视化在ICG给药后1至4小时内。延迟窗口ICG（DWIG）中颅内脑膜瘤的平均信号与背景比（SBR）为3.3±2.6。钆增强T1肿瘤信号与脑的比值（T1BR）（2.5±0.9）与肿瘤SBR显著相关（r = 0.016）。表示血脑屏障通透性的Ktrans在动态对比增强磁共振成像（MRI）上与肿瘤SBR（P < 0.0001）和T1BR（r = 0.013）显著相关。DWIG对脑膜瘤的敏感性为94%，特异性为38%，阳性预测值（PPV）为76%，阴性预测值（NPV）为75%。这是第一项使用DWIG荧光引导手术在术中通过显微镜对脑膜瘤和硬脑膜尾征进行可视化的初步研究。DWIG在平均SBR方面与第二窗口ICG相当。钆增强T1肿瘤信号可能预测颅内脑膜瘤的NIR荧光。动态对比增强MRI上的Ktrans所示的血脑屏障通透性可导致MRI上的钆增强以及ICG滞留和NIR肿瘤荧光。
