Department of Neurosurgery, Fujita Health University, Aichi, Japan.
Department of Neurosurgery, Tokyo Medical Center, National Hospital Organization, Tokyo, Japan; Department of Neurosurgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
World Neurosurg. 2023 Jul;175:e218-e229. doi: 10.1016/j.wneu.2023.03.055. Epub 2023 Mar 15.
For endoscopic endonasal surgery of pituitary tumors, tissue identification and intraoperative judgment depend largely on surgeon expertise. In the present study, we assess whether the delayed-window indocyanine green (ICG) technique can identify pituitary gland tumors in real-time during surgery and analyze the mechanism of ICG fluorescence in the pituitary gland and tumor.
Twenty-five patients with a pituitary adenoma were administered 12.5 mg of ICG intravenously during surgery. Thereafter, near-infrared (NIR) visualization was performed from 0 to 180 minutes. Only 8 patients underwent dynamic contrast-enhanced perfusion magnetic resonance imaging (MRI) owing to predicaments with insurance coverage. Consequently, we analyzed these 8 patients extensively.
The pituitary gland and pituitary adenoma were visualized in all 25 patients with NIR fluorescence. The relative ratio of the fluorescence emission of the normal gland to that of the tumor (signal/background ratio [SBR] of the normal gland vs. the tumor) had increased after 15 minutes, peaking (5.8) at 90 minutes, demonstrating that the pituitary gland was distinctly visualized during that period. The tumor/blood (SBR tumor) and normal gland/blood (SBR gland) NIR fluorescence was significantly and positively correlated with each transfer constant on dynamic contrast-enhanced MRI, indicating vascular permeability.
The results from the present study exhibit the utility of the delayed-window ICG technique in distinguishing the normal pituitary gland from a tumor during endoscopic endonasal surgery from 15 to 90 minutes after ICG administration. Permeability can contribute to gadolinium enhancement on MRI, as well as ICG retention and NIR fluorescence in a normal pituitary gland and tumor.
对于经鼻内镜垂体瘤手术，组织识别和术中判断在很大程度上依赖于外科医生的专业知识。本研究旨在评估迟窗吲哚菁绿（ICG）技术是否能实时识别手术中的垂体瘤，并分析 ICG 在垂体和肿瘤中荧光的机制。
25 例垂体腺瘤患者在手术中静脉注射 12.5mg ICG。此后，在 0 至 180 分钟进行近红外（NIR）可视化。由于保险覆盖的困境，只有 8 例患者接受了动态对比增强磁共振灌注成像（MRI）。因此，我们对这 8 例患者进行了详细分析。
25 例患者均用 NIR 荧光显示出垂体和垂体腺瘤。正常腺体与肿瘤荧光发射的相对比值（正常腺体与肿瘤的信号/背景比[SBR]）在 15 分钟后增加，在 90 分钟时达到峰值（5.8），表明在此期间可以明显显示正常垂体。肿瘤/血液（SBR 肿瘤）和正常腺体/血液（SBR 腺体）NIR 荧光与动态对比增强 MRI 上每个转移常数均呈显著正相关，表明血管通透性。
本研究结果表明，迟窗 ICG 技术在经鼻内镜手术后 15 至 90 分钟内，可用于区分正常垂体和肿瘤。通透性可导致 MRI 上的钆增强以及正常垂体和肿瘤中 ICG 的保留和 NIR 荧光。
