• VerstegenMarco J TMJTDepartment of Neurosurgery, Leiden University Medical Center and Center for Endocrine Tumors Leiden, Leiden, the Netherlands., Quirijn R J G Tummers, Pieter J Schutte, Alberto M Pereira, Wouter R van Furth, van de VeldeCornelis J HCJHDepartment of Surgery, Leiden University Medical Center and Center for Endocrine Tumors Leiden, Leiden, the Netherlands., MalessyMartijn J AMJADepartment of Neurosurgery, Leiden University Medical Center and Center for Endocrine Tumors Leiden, Leiden, the Netherlands., and Alexander L Vahrmeijer.
• Department of Neurosurgery, Leiden University Medical Center and Center for Endocrine Tumors Leiden, Leiden, the Netherlands.
• Oper Neurosurg (Hagerstown). 2016 Sep 1; 12 (3): 260-268.

BackgroundThe intraoperative distinction between normal and abnormal pituitary tissue is crucial during pituitary adenoma surgery to obtain a complete tumor resection while preserving endocrine function. Near-infrared (NIR) fluorescence imaging is a technique to intraoperatively visualize tumors by using indocyanine green (ICG), a contrast agent allowing visualization of differences in tissue vascularization. Although NIR fluorescence imaging has been described in pituitary surgery, it has, in contrast to other surgical areas, never become widely used.ObjectiveTo evaluate NIR fluorescence imaging in pituitary surgery, both qualitatively and quantitatively, and to assess the additional value of resecting adenoma tissue under NIR fluorescence guidance.MethodsWe included 10 patients planned to undergo transnasal transsphenoidal selective adenomectomy. Patients received multiple intravenous administrations of 5 mg ICG, up to a maximum of 15 mg per patient. Endoscopic NIR fluorescence imaging was performed at multiple points in time. The NIR fluorescent signal in both the adenoma and pituitary gland was obtained, and the fluorescence contrast ratio was assessed.ResultsFour patients had Cushing disease, 1 had acromegaly, and 1 had a prolactinoma. Four patients had a nonfunctioning macroadenoma. In 9 of 10 patients with a histologically proven pituitary adenoma, the normal pituitary gland showed a stronger fluorescent signal than the adenoma. A fluorescence contrast ratio of normal pituitary gland to adenoma of 1.5 ± 0.2 was obtained. In 2 patients; adenoma resection was actually performed under NIR fluorescence guidance instead of under white light.ConclusionNIR fluorescence imaging can easily and safely be implemented in pituitary surgery. The timing of ICG administration is important for optimal results and warrants further study. It appears that injection of ICG can best be postponed until some part of the normal pituitary gland is identified. Subsequent repeated low-dose ICG administrations improved the distinction between adenoma and gland.

11 keywords...

hide…