Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Sep 2016
Intraoperative Identification of a Normal Pituitary Gland and an Adenoma Using Near-Infrared Fluorescence Imaging and Low-Dose Indocyanine Green.
The 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. ⋯ NIR 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.
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Oper Neurosurg (Hagerstown) · Sep 2016
Anatomical Variations of the Anterior Clinoid Process: A Study of 597 Skull Base Computerized Tomography Scans.
The anterior clinoid process (ACP) is surrounded by a complex anatomy; variations include pneumatization and the formation of bone bridges with the middle and posterior clinoid, which complicate surgery. The key to avoiding microsurgical complications is a perfect understanding of this anatomy. ⋯ At least 1 variation in ACP anatomy was found in 38.7% of cases with this simple method. Thus, a preoperative computed tomography scan could improve surgical procedures that involve removal of the anterior clinoid process.