Tricks and traps of ICG endoscopy for effectively applying endoscopic transsphenoidal surgery to pituitary adenoma
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ORIGINAL ARTICLE
Tricks and traps of ICG endoscopy for effectively applying endoscopic transsphenoidal surgery to pituitary adenoma Akihiro Inoue 1 & Shohei Kohno 1 & Takanori Ohnishi 2 & Naoya Nishida 3 & Satoshi Suehiro 1 & Yawara Nakamura 1 & Shirabe Matsumoto 1 & Masahiro Nishikawa 1 & Saya Ozaki 1 & Seiji Shigekawa 1 & Hideaki Watanabe 1 & Hidenori Senba 4 & Hironobu Nakaguchi 4 & Mashio Taniwaki 5 & Bunzo Matsuura 4 & Riko Kitazawa 5 & Takeharu Kunieda 1 Received: 11 May 2020 / Revised: 2 August 2020 / Accepted: 1 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Differentiating tumor from normal pituitary gland is very important for achieving complete resection without complications in endoscopic endonasal transsphenoidal surgery (ETSS) for pituitary adenoma. To facilitate such surgery, we investigated the utility of indocyanine green (ICG) fluorescence endoscopy as a tool in ETSS. Twenty-four patients with pituitary adenoma were enrolled in the study and underwent ETSS using ICG endoscopy. After administering 12.5 mg of ICG twice an operation with an interval > 30 min, times from ICG administration to appearance of fluorescence on vital structures besides the tumor were measured. ICG endoscopy identified vital structures by the phasic appearance of fluorescent signals emitted at specific consecutive elapsed times. Elapsed times for internal carotid arteries did not differ according to tumor size. Conversely, as tumor size increased, elapsed times for normal pituitary gland were prolonged but those for the tumor were reduced. ICG endoscopy revealed a clear boundary between tumors and normal pituitary gland and enabled confirmation of no more tumor. ICG endoscopy could provide a useful tool for differentiating tumor from normal pituitary gland by evaluating elapsed times to fluorescence in each structure. This method enabled identification of the boundary between tumor and normal pituitary gland under conditions of a low-fluorescence background, resulting in complete tumor resection with ETSS. ICG endoscopy will contribute to improve the resection rate while preserving endocrinological functions in ETSS for pituitary adenoma. Keywords Endoscopic endonasal transsphenoidal surgery . Indocyanine green fluorescence . Pituitary
Introduction Endoscopic transsphenoidal endonasal surgery (ETSS) has become a more common procedure and offers several technical * Akihiro Inoue [email protected] 1
Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
2
Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime 790-0052, Japan
3
Department of Otolaryngology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
4
Department of Lifestyle-Related Medicine and Endocrinology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
5
Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
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