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Yang Y, Jiang Q, Zhang F. Nanocrystals for Deep-Tissue In Vivo Luminescence Imaging in the Near-Infrared Region. Chem Rev 2024; 124:554-628. [PMID: 37991799 DOI: 10.1021/acs.chemrev.3c00506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
In vivo imaging technologies have emerged as a powerful tool for both fundamental research and clinical practice. In particular, luminescence imaging in the tissue-transparent near-infrared (NIR, 700-1700 nm) region offers tremendous potential for visualizing biological architectures and pathophysiological events in living subjects with deep tissue penetration and high imaging contrast owing to the reduced light-tissue interactions of absorption, scattering, and autofluorescence. The distinctive quantum effects of nanocrystals have been harnessed to achieve exceptional photophysical properties, establishing them as a promising category of luminescent probes. In this comprehensive review, the interactions between light and biological tissues, as well as the advantages of NIR light for in vivo luminescence imaging, are initially elaborated. Subsequently, we focus on achieving deep tissue penetration and improved imaging contrast by optimizing the performance of nanocrystal fluorophores. The ingenious design strategies of NIR nanocrystal probes are discussed, along with their respective biomedical applications in versatile in vivo luminescence imaging modalities. Finally, thought-provoking reflections on the challenges and prospects for future clinical translation of nanocrystal-based in vivo luminescence imaging in the NIR region are wisely provided.
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Affiliation(s)
- Yang Yang
- College of Energy Materials and Chemistry, State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, Inner Mongolia University, Hohhot 010021, China
| | - Qunying Jiang
- College of Energy Materials and Chemistry, State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, Inner Mongolia University, Hohhot 010021, China
| | - Fan Zhang
- College of Energy Materials and Chemistry, State Key Laboratory of Reproductive Regulation and Breeding of Grassland Livestock, Inner Mongolia University, Hohhot 010021, China
- Department of Chemistry, State Key Laboratory of Molecular Engineering of Polymers, Shanghai Key Laboratory of Molecular Catalysis and Innovative Materials, Fudan University, Shanghai 200433, China
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2
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Ajmera S, Blue R, Lee JYK. Fluorophores in Endoscopic Neurosurgery. Adv Tech Stand Neurosurg 2024; 52:21-28. [PMID: 39017784 DOI: 10.1007/978-3-031-61925-0_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
The complexity of intracranial anatomy and pathologies warrants the optimization of multimodal techniques to ensure safe and effective surgical treatment. Endoscopy is being more widely implemented in intracranial procedures as an important visualization tool, as it can offer panoramic views of deep structures while reducing the invasiveness of approaches. Fluorophores are frequently utilized to augment the identification of intracranial anatomic landmarks and pathologies. This chapter discusses the integration of these two surgical adjuncts, highlighting the key fluorophores used in endoscopic neurosurgery and their clinical applications.
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Affiliation(s)
- Sonia Ajmera
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Rachel Blue
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - John Y K Lee
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Kim MS, Cha JH, Lee S, Han L, Park W, Ahn JS, Park SC. Deep-Learning-Based Cerebral Artery Semantic Segmentation in Neurosurgical Operating Microscope Vision Using Indocyanine Green Fluorescence Videoangiography. Front Neurorobot 2022; 15:735177. [PMID: 35095454 PMCID: PMC8790180 DOI: 10.3389/fnbot.2021.735177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022] Open
Abstract
There have been few anatomical structure segmentation studies using deep learning. Numbers of training and ground truth images applied were small and the accuracies of which were low or inconsistent. For a surgical video anatomy analysis, various obstacles, including a variable fast-changing view, large deformations, occlusions, low illumination, and inadequate focus occur. In addition, it is difficult and costly to obtain a large and accurate dataset on operational video anatomical structures, including arteries. In this study, we investigated cerebral artery segmentation using an automatic ground-truth generation method. Indocyanine green (ICG) fluorescence intraoperative cerebral videoangiography was used to create a ground-truth dataset mainly for cerebral arteries and partly for cerebral blood vessels, including veins. Four different neural network models were trained using the dataset and compared. Before augmentation, 35,975 training images and 11,266 validation images were used. After augmentation, 260,499 training and 90,129 validation images were used. A Dice score of 79% for cerebral artery segmentation was achieved using the DeepLabv3+ model trained using an automatically generated dataset. Strict validation in different patient groups was conducted. Arteries were also discerned from the veins using the ICG videoangiography phase. We achieved fair accuracy, which demonstrated the appropriateness of the methodology. This study proved the feasibility of operating field view of the cerebral artery segmentation using deep learning, and the effectiveness of the automatic blood vessel ground truth generation method using ICG fluorescence videoangiography. Using this method, computer vision can discern blood vessels and arteries from veins in a neurosurgical microscope field of view. Thus, this technique is essential for neurosurgical field vessel anatomy-based navigation. In addition, surgical assistance, safety, and autonomous surgery neurorobotics that can detect or manipulate cerebral vessels would require computer vision to identify blood vessels and arteries.
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Affiliation(s)
- Min-seok Kim
- Clinical Research Team, Deepnoid, Seoul, South Korea
| | - Joon Hyuk Cha
- Department of Internal Medicine, Inha University Hospital, Incheon, South Korea
| | - Seonhwa Lee
- Department of Bio-convergence Engineering, Korea University, Seoul, South Korea
| | - Lihong Han
- Clinical Research Team, Deepnoid, Seoul, South Korea
- Department of Computer Science and Engineering, Soongsil University, Seoul, South Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seong-Cheol Park
- Clinical Research Team, Deepnoid, Seoul, South Korea
- Department of Neurosurgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
- Department of Neurosurgery, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, South Korea
- Department of Neurosurgery, Hallym Hospital, Incheon, South Korea
- *Correspondence: Seong-Cheol Park
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Inoue A, Kohno S, Ohnishi T, Nishida N, Suehiro S, Nakamura Y, Matsumoto S, Nishikawa M, Ozaki S, Shigekawa S, Watanabe H, Senba H, Nakaguchi H, Taniwaki M, Matsuura B, Kitazawa R, Kunieda T. Tricks and traps of ICG endoscopy for effectively applying endoscopic transsphenoidal surgery to pituitary adenoma. Neurosurg Rev 2020; 44:2133-2143. [PMID: 32889658 DOI: 10.1007/s10143-020-01382-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/02/2020] [Accepted: 09/01/2020] [Indexed: 11/27/2022]
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.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Shohei Kohno
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takanori Ohnishi
- Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime, 790-0052, Japan
| | - Naoya Nishida
- Department of Otolaryngology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Satoshi Suehiro
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yawara Nakamura
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiro Nishikawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Saya Ozaki
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hidenori Senba
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hironobu Nakaguchi
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mashio Taniwaki
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Bunzo Matsuura
- Department of Lifestyle-Related Medicine and Endocrinology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan
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Wong AK, Wong RH. Keyhole clipping of a low-lying basilar apex aneurysm without posterior clinoidectomy utilizing endoscopic indocyanine green video angiography. Surg Neurol Int 2020; 11:31. [PMID: 32257557 PMCID: PMC7110063 DOI: 10.25259/sni_582_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/11/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Basilar apex (BX) aneurysms are surgically challenging due to their anatomic location, need to traverse neurovascular structures, and proximity to multiple perforator arteries. Surgical approaches often require extensive bone resection and neurovascular manipulation. Visualization of low-lying BX aneurysms is typically obscured by the posterior clinoid and upper clivus and poses a unique challenge. Subtemporal or anterolateral approaches with a posterior clinoidectomy are often required to achieve adequate exposure, though these maneuvers can add invasiveness, risk, and morbidity to the procedure. Endoscopes and, more recently, fluoroscopic angiography capable endoscopes offer the possibility of providing improved visualization with less exposure allowing for minimally invasive clipping. Case Description: We present the case of a 42-year-old female with incidentally found 5 mm middle cerebral artery and 5 mm BX aneurysms. She underwent a minimally invasive supraorbital keyhole craniotomy for the clipping of both aneurysms. While the posterior clinoid obstructed the necessary visualization for the BX aneurysm, use of endoscopy and endoscopic fluoroscopic angiography allowed for safe and successful clipping without the need for a posterior clinoidectomy. Conclusion: This represents the first reported case of a BX aneurysm clipping through a minimally invasive keyhole craniotomy using endoscopic indocyanine green video angiography. Use of endoscopic indocyanine green angiography, combined with keyhole endoscopic approaches, allows for safe minimally invasive clipping of challenging posterior circulation aneurysms.
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Affiliation(s)
- Andrew K Wong
- Department of Neurosurgery, Rush University Medical Center, Chicago
| | - Ricky H Wong
- Department of Neurosurgery, NorthShore University HealthSystem, Evanston, Illinois
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Zhao X, Belykh E, Cavallo C, Valli D, Gandhi S, Preul MC, Vajkoczy P, Lawton MT, Nakaji P. Application of Fluorescein Fluorescence in Vascular Neurosurgery. Front Surg 2019; 6:52. [PMID: 31620443 PMCID: PMC6759993 DOI: 10.3389/fsurg.2019.00052] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022] Open
Abstract
Background: Fluorescein sodium (FNa) is a fluorescent drug with a long history of use for assessing retinal blood flow in ophthalmology; however, its application in vascular neurosurgery is only now gaining popularity. This review summarizes the current knowledge about using FNa videoangiography in vascular neurosurgery. Methods: We performed a literature review on the usage of FNa for fluorescent videoangiography procedures in neurosurgery. We analyzed methods of injection, dosages of FNa, visualizing platforms, and interpretation of FNa videoangiography. We also reviewed practical applications of FNa videoangiography during various vascular neurosurgeries. Results: FNa videoangiography can be performed with intraarterial (intracarotid) or intravenous dye injections. Both methods provide excellent resolution with enhanced fluorescence that shows intravascular blood flow on top of visible surrounding anatomy, and both allow simultaneous purposeful microsurgical manipulations. Although it is invasive, an intracarotid FNa injection results in faster contrast appearance and higher-intensity fluorescence and requires a lower dose per injection (reported range, 1–50 mg) compared with peripheral intravenous FNa injection (reported range, 75–2,000 mg or 1–1.5 mg/kg body weight). Four optical excitation/detection tools for FNa videoangiography have been successfully used: conventional xenon-light operating microscope with a special filter set, pencil-type light-emitting diode probe with a filter set, laser-illumination operating microscope, and an endoscope with a filter set. FNa videoangiography was reported to be feasible and useful in various clinical scenarios, such as examining the feeders and drainers in arteriovenous malformation surgery, checking the patency of a microvascular anastomosis, and assessing blood flow during aneurysm clipping. FNa videoangiography can be repeated during the same procedure and used along with indocyanine green (ICG) videoangiography. Conclusions: Compared with ICG videoangiography, FNa videoangiography has the advantages of enabling real-time inspection and better visualization at deep locations; however, thick vessel walls limit visualization of FNa in larger vessels. FNa videoangiography is a useful tool in multiple neurovascular scenarios and merits further studies to establish its clinical value.
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Affiliation(s)
- Xiaochun Zhao
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Evgenii Belykh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States.,Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Claudio Cavallo
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Daniel Valli
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Sirin Gandhi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Mark C Preul
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
| | - Peter Nakaji
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, United States
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Goryaynov SA, Okhlopkov VA, Golbin DA, Chernyshov KA, Svistov DV, Martynov BV, Kim AV, Byvaltsev VA, Pavlova GV, Batalov A, Konovalov NA, Zelenkov PV, Loschenov VB, Potapov AA. Fluorescence Diagnosis in Neurooncology: Retrospective Analysis of 653 Cases. Front Oncol 2019; 9:830. [PMID: 31552168 PMCID: PMC6747044 DOI: 10.3389/fonc.2019.00830] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 08/13/2019] [Indexed: 12/14/2022] Open
Abstract
Objective: This study is to analyze fluorescence sensitivity in the diagnosis of brain and spinal cord tumors. Material and methods: The authors conducted a multicenter retrospective analysis of data on 653 cases in 641 patients: 553 of them had brain tumors and 88 spinal cord tumors. Brain tumor resection was performed in 523 patients, of whom 484 were adults and 39 children. The analyzed series was presented by 320 gliomas, 101 meningiomas, and 72 metastases. A stereotactic biopsy was performed in 20 patients and endoscopic surgery in 10 patients. In all cases, 20 mg/kg of 5-Aminolaevulinic acid was administered orally 2-h before surgery. All surgical interventions were performed with a microscope BLUE 400 to visualize fluorescence, while endoscopic surgery-with an endoscope equipped with a fluorescent module. Fluorescence spectroscopy was conducted in 20 cases of stereotactic biopsies and in 88 cases of spinal cord tumors. Results: Among adult brain tumors operated by microsurgical techniques, meningiomas showed the highest 5-ALA fluorescence sensitivity 94% (n = 95/101), brain metastases 84.7% (n = 61/72), low-grade gliomas 46.4% (n = 26/56), and high-grade gliomas 90.2% (n = 238/264). In children the highest 5-ALA visible fluorescence was observed in anaplastic astrocytomas 100% (n = 4/4) and in anaplastic ependymomas 100% (n = 4/4); in low-grade gliomas it made up 31.8% (n = 7/22). As for the spinal cord tumors in adults, the highest sensitivity was demonstrated by glioblastomas 100% (n = 4/4) and by meningiomas 100% (n = 4/4); Fluorescence was not found in gemangioblastomas (n = 0/6) and neurinomas (n = 0/4). Fluorescence intensity reached 60% (n = 6/10) in endoscopic surgery and 90% (n = 18/20) in stereotactic biopsy. Conclusion: 5-ALA fluorescence diagnosis proved to be most sensitive in surgery of HGG and meningioma (90.2 and 94.1%, respectively). Sensitivity in surgery of intracranial metastases and spinal cord tumors was slightly lower (84.7 and 63.6%, correspondingly). The lowest fluorescence sensitivity was marked in pediatric tumors and LGG (50 and 46.4%, correspondingly). Fluorescence diagnosis can also be used in transnasal endoscopic surgery of skull base tumors and in stereotactic biopsy.
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Affiliation(s)
- Sergey A. Goryaynov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Vladimir A. Okhlopkov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Denis A. Golbin
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Konstantin A. Chernyshov
- I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Dmitrij V. Svistov
- S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St-Petersburg, Russia
| | - Boris V. Martynov
- S. M. Kirov Military Medical Academy of the Ministry of Defense of the Russian Federation, St-Petersburg, Russia
| | - Alexandr V. Kim
- V. A. Almazov Federal North-West Medical Research Centre of the Ministry of Health of the Russian Federation, St-Petersburg, Russia
| | - Vadim A. Byvaltsev
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Department of Neurosurgery, Irkutsk State Medical University, Irkutsk, Russia
| | - Galina V. Pavlova
- Institute of Gene Biology, Russian Academy of Science, Moscow, Russia
| | - Artem Batalov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Nikolay A. Konovalov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Petr V. Zelenkov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Victor B. Loschenov
- Prokhorov General Physics Institute of the Russian Academy of Science, Moscow, Russia
- National Research Nuclear University MEPhI, Moscow, Russia
| | - Alexandr A. Potapov
- N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of the Russian Federation, Moscow, Russia
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Norat P, Soldozy S, Elsarrag M, Sokolowski J, Yaǧmurlu K, Park MS, Tvrdik P, Kalani MYS. Application of Indocyanine Green Videoangiography in Aneurysm Surgery: Evidence, Techniques, Practical Tips. Front Surg 2019; 6:34. [PMID: 31281818 PMCID: PMC6596320 DOI: 10.3389/fsurg.2019.00034] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/22/2019] [Indexed: 12/29/2022] Open
Abstract
Establishing blood vessel patency in neurovascular surgery is an essential component in treating cerebrovascular disorders. Given the difficulty in confirming complete obliteration of the aneurysm sac, ICG videoangiography has emerged as an intraoperative tool that provides neurosurgeons immediate feedback on the status of vessel flow, allowing for surgical modifications to be made without delay. ICG initially emerged as a tool for assessing hepatic, cardiac, and retinovascular function. It is an inert compound with a high affinity for plasma proteins and fluorescence properties making it the ideal candidate for assessment of vessel patency in neurovascular procedures. Requiring only a bolus peripheral vein injection and integration of a near-infrared imaging device into the surgical microscope, ICG can be visualized without disrupting operating room workflow or the surgical field. Quick response time, high-spatial resolution, and low complication rates are features of ICG videoangiography that prove advantageous when compared to the gold standard intra- and postoperative digital subtraction angiography (DSA). Despite this, ICG is not without limitations, specifically in the setting of atherosclerotic vessels, giant, and complex aneurysms. Additionally, there are instances where DSA may prove superior in detecting vessel stenosis and outflow obstruction, prompting the recommendation of ICG as an adjunct to, rather than complete replacement of DSA. In this article, the authors provide a brief overview of the biochemical properties and historical origins of ICG viedoangiography in addition to discussing its current application in aneurysm surgery.
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Affiliation(s)
| | | | | | | | | | | | | | - M. Yashar S. Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, VA, United States
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9
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Nagaya T, Nakamura YA, Choyke PL, Kobayashi H. Fluorescence-Guided Surgery. Front Oncol 2017; 7:314. [PMID: 29312886 PMCID: PMC5743791 DOI: 10.3389/fonc.2017.00314] [Citation(s) in RCA: 225] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/05/2017] [Indexed: 01/02/2023] Open
Abstract
Surgical resection of cancer remains an important treatment modality. Despite advances in preoperative imaging, surgery itself is primarily guided by the surgeon’s ability to locate pathology with conventional white light imaging. Fluorescence-guided surgery (FGS) can be used to define tumor location and margins during the procedure. Intraoperative visualization of tumors may not only allow more complete resections but also improve safety by avoiding unnecessary damage to normal tissue which can also reduce operative time and decrease the need for second-look surgeries. A number of new FGS imaging probes have recently been developed, complementing a small but useful number of existing probes. In this review, we describe current and new fluorescent probes that may assist FGS.
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Affiliation(s)
- Tadanobu Nagaya
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yu A Nakamura
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Peter L Choyke
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Hisataka Kobayashi
- Molecular Imaging Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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10
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Catapano G, Sgulò F, Laleva L, Columbano L, Dallan I, de Notaris M. Multimodal use of indocyanine green endoscopy in neurosurgery: a single-center experience and review of the literature. Neurosurg Rev 2017; 41:985-998. [PMID: 28477043 PMCID: PMC6133047 DOI: 10.1007/s10143-017-0858-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 04/13/2017] [Indexed: 12/28/2022]
Abstract
During the last 10 years, microscope-integrated indocyanine green fluorescence (m-ICG) has been widely used for assessing real-time blood flow during aneurysm surgery. More recently, an endoscope-integrated indocyanine green fluorescence (e-ICG) has been adopted as a versatile tool during different endoscopic neurosurgical procedures. The purpose of the present report is to evaluate multimodal applications of e-ICG during different endonasal, intraventricular, aneurysm and brain tumor surgeries and provide technical nuances. In addition, we reviewed the literature and identified and compare several overlapping case series of patients treated via an endoscopic integrated indocyanine green fluorescence technique. A total of 40 patients were retrospectively evaluated. Patients were divided into four main groups: (1) endoscopic endonasal approaches (n = 14); (2) ventricular endoscopic approach including patients undergoing third ventriculostomy (n = 8) and tumor biopsy (n = 1); (3) aneurysms surgery (n = 9); and (4) brain parenchymal tumors (n = 8). All patients were successfully treated using the e-ICG dynamic endoscopic visualization, and there were no perioperative complications. Such unique features open up a promising field of applications beyond the use of m-ICG in different surgical field due to the longer duration of e-ICG fluorescence up to 35 ± 7 min. E-ICG represents a new and effective technique for longer real-time visualization of vascular structures preserving normal tissues and functions during different transcranial and endonasal approaches. As the technology and e-ICG resolution improves, the technique has the potential to become a critical tool for different applications in neurosurgery.
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Affiliation(s)
- Giuseppe Catapano
- Department of Neuroscience, Neurosurgery Operative Unit, "G. Rummo" Hospital, Via Pacevecchia no. 53, 82100, Benevento, Italy
| | - Francesco Sgulò
- Division of Neurosurgery, Department of Neurological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Lili Laleva
- Department of Neurosurgery, Tokuda Hospital Sofia, Sofia, Bulgaria
| | - Laura Columbano
- Department of Neuroscience, Neurosurgery Operative Unit, "G. Rummo" Hospital, Via Pacevecchia no. 53, 82100, Benevento, Italy
| | - Iacopo Dallan
- First Otorhinolaryngologic Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Matteo de Notaris
- Department of Neuroscience, Neurosurgery Operative Unit, "G. Rummo" Hospital, Via Pacevecchia no. 53, 82100, Benevento, Italy.
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Cho WS, Kim JE, Kang HS, Son YJ, Bang JS, Oh CW. Keyhole Approach and Neuroendoscopy for Cerebral Aneurysms. J Korean Neurosurg Soc 2017; 60:275-281. [PMID: 28490152 PMCID: PMC5426456 DOI: 10.3340/jkns.2017.0101.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 01/27/2017] [Accepted: 01/31/2017] [Indexed: 11/27/2022] Open
Abstract
Treating diseases in the field of neurosurgery has progressed concomitantly with technical advances. Here, as a surgical armamentarium for the treatment of cerebral aneurysms, the history and present status of the keyhole approach and the use of neuroendoscopy are reviewed, including our clinical data. The major significance of keyhole approach is to expose an essential space toward a target, and to minimize brain exposure and retraction. Among several kinds of keyhole approaches, representative keyhole approaches for anterior circulation aneurysms include superciliary and lateral supraorbital, frontolateral, mini-pterional and mini-interhemispheric approaches. Because only a fixed and limited approach angle toward a target is permitted via the keyhole, however, specialized surgical devices and preoperative planning are very important. Neuroendoscopy has helped to widen the indications of keyhole approaches because it can supply illumination and visualization of structures beyond the straight line of microscopic view. In addition, endoscopic indocyanine green fluorescence angiography is useful to detect and correct any compromise of the perforators and parent arteries, and incomplete clipping. The authors think that keyhole approach and neuroendoscopy are just an intermediate step and robotic neurosurgery would be realized in the near future.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea
| | - Young-Je Son
- Department of Neurosurgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Korea
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Cho WS, Kim JE, Kim SH, Kim HC, Kang U, Lee DS. Endoscopic Fluorescence Angiography with Indocyanine Green : A Preclinical Study in the Swine. J Korean Neurosurg Soc 2015; 58:513-7. [PMID: 26819685 PMCID: PMC4728088 DOI: 10.3340/jkns.2015.58.6.513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 07/20/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Microscopic indocyanine green (ICG) angiography is useful for identifying the completeness of aneurysm clipping and the preservation of parent arteries and small perforators. Neuroendoscopy is helpful for visualizing structures beyond the straight line of the microscopic view. We evaluated our prototype of endoscopic ICG fluorescence angiography in swine, which we developed in order to combine the merits of microscopic ICG angiography and endoscopy. METHODS Our endoscopic ICG system consists of a camera, a light source, a display and software. This system can simultaneously display real-time visible and near infrared fluorescence imaging on the same monitor. A commercially available endoscope was used, which was 4 mm in diameter and had an angle of 30°. A male crossbred swine was used. RESULTS Under general anesthesia, a small craniotomy was performed and the brain surface of the swine was exposed. ICG was injected via the ear vein with a bolus dose of 0.3 mg/kg. Visible and ICG fluorescence images of cortical vessels were simultaneously observed on the display monitor at high resolution. The real-time merging of the visible and fluorescent images corresponded well. CONCLUSION Simultaneous visible color and ICG fluorescent imaging of the cortical vessels in the swine brain was satisfactory. Technical improvement and clinical implication are expected.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sae Hoon Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Uk Kang
- Korea Electrotechnology Research Institute Russia Science Seoul Center, Seoul, Korea
| | - Dae-Sic Lee
- Korea Electrotechnology Research Institute Russia Science Seoul Center, Seoul, Korea
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Abstract
The neuroendoscope, with its higher magnification, better observation, and additional illumination, can provide us information that may not be available with the microscope in aneurysm surgery. Furthermore, recent advancement of the holding systems for the endoscope allows surgeons to perform microsurgical manipulation using both hands under the simultaneous endoscopic and microscopic monitoring. With this procedure, surgeons can inspect hidden structures, dissect perforators at the back of the aneurysm, identify important vessel segments without retraction of the aneurysm or arteries, and check for completion of clipping. In addition, we have recently applied endoscopic indocyanine green video angiography to aneurysm surgery. This newly developed technique can offer real-time assessment of the blood flow of vasculatures in the dead angles of the microscope, and will reduce operative morbidity related to vascular occlusion, improve the durability of aneurysm surgery by reducing incomplete clipping, and thus promote the outcome of aneurysm surgery.
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Affiliation(s)
- Hideyuki Yoshioka
- Department of Neurosurgery, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi
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14
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Yamada Y, Kato Y, Ishihara K, Ito K, Kaito T, Nouri M, Oheda M, Inamasu J, Hirose Y. Role of endoscopy in multi-modality monitoring during aneurysm surgery: A single center experience with 175 consecutive unruptured aneurysms. Asian J Neurosurg 2015; 10:52. [PMID: 25767585 PMCID: PMC4352638 DOI: 10.4103/1793-5482.151518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective and Background: Unruptured aneurysm surgery is a challenge to all vascular neurosurgeons as the patient is asymptomatic and no even slight neurological deficits should be expected postoperatively. To this aim, multi-modality checking of the vessels during the surgery is highly recommended to assure of the patency of the parent and perforator arteries next to an aneurysm. In this paper, we present our experience in the last 1.5 years with emphasis on the role of endoscope assisted microsurgery. Methods: One hundred and seventy-five patients with unruptured intracranial aneurysms were operated in our institute in the last 1½ years. All patients underwent endoscope assisted microsurgery with pre- and post-clipping indocyanine green angiography. In selected cases, motor evoked potential monitoring was implemented. Results: No mortality was observed in this period, and only 6 patients (3.4%) suffered new permanent neurological deficits postoperatively. Our illustrative cases show how endoscopy may help the surgeon to visualize hidden vessels behind and medial to an aneurysm. Conclusions: Our results indicated that multi-modality monitoring during unruptured aneurysm surgeries is associated with excellent outcome. Endoscope is able to show blind corners during aneurysm surgery which cannot be routinely observed with microscope and its application in aneurysm surgery assists the surgeon to make certain of complete neck clipping and preservation of perforating arteries around the aneurysm.
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Affiliation(s)
- Yasuhiro Yamada
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yoko Kato
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Kohei Ishihara
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Keisuke Ito
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Takafumi Kaito
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Mohsen Nouri
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Motoki Oheda
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Joji Inamasu
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yuichi Hirose
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Aichi, Japan
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Inoue A, Ohnishi T, Kohno S, Nishida N, Nakamura Y, Ohtsuka Y, Matsumoto S, Ohue S. Usefulness of an Image Fusion Model Using Three-Dimensional CT and MRI with Indocyanine Green Fluorescence Endoscopy as a Multimodal Assistant System in Endoscopic Transsphenoidal Surgery. Int J Endocrinol 2015; 2015:694273. [PMID: 26339240 PMCID: PMC4539066 DOI: 10.1155/2015/694273] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/15/2015] [Indexed: 11/25/2022] Open
Abstract
Purpose. We investigate the usefulness of multimodal assistant systems using a fusion model of preoperative three-dimensional (3D) computed tomography (CT) and magnetic resonance imaging (MRI) along with endoscopy with indocyanine green (ICG) fluorescence in establishing endoscopic endonasal transsphenoidal surgery (ETSS) as a more effective treatment procedure. Methods. Thirty-five consecutive patients undergoing ETSS in our hospital between April 2014 and March 2015 were enrolled in the study. In all patients, fusion models of 3D-CT and MRI were created by reconstructing preoperative images. In addition, in 10 patients, 12.5 mg of ICG was intravenously administered, allowing visualization of surrounding structures. We evaluated the accuracy and utility of these combined modalities in ETSS. Results. The fusion model of 3D-CT and MRI clearly demonstrated the complicated structures in the sphenoidal sinus and the position of the internal carotid arteries (ICAs), even with extensive tumor infiltration. ICG endoscopy enabled us to visualize the surrounding structures by the phasic appearance of fluorescent signals emitted at specific consecutive elapsed times. Conclusions. Preoperative 3D-CT and MRI fusion models with intraoperative ICG endoscopy allowed distinct visualization of vital structures in cases where tumors had extensively infiltrated the sphenoidal sinus. Additionally, the ICG endoscope was a useful real-time monitoring tool for ETSS.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
- *Akihiro Inoue:
| | - Takanori Ohnishi
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shohei Kohno
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Naoya Nishida
- Department of Otolaryngology, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yawara Nakamura
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoshihiro Ohtsuka
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shirabe Matsumoto
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shiro Ohue
- Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
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Hide T, Yano S, Kuratsu JI. Indocyanine green fluorescence endoscopy at endonasal transsphenoidal surgery for an intracavernous sinus dermoid cyst: case report. Neurol Med Chir (Tokyo) 2014; 54:999-1003. [PMID: 25446381 PMCID: PMC4533358 DOI: 10.2176/nmc.cr.2014-0087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The complete resection of intracavernous sinus dermoid cysts is very difficult due to tumor tissue adherence to important anatomical structures such as the internal carotid artery (ICA), cavernous sinus, and cranial nerves. As residual dermoid cyst tissue sometimes induces symptoms and repeat surgery may be required after cyst recurrence, minimal invasiveness is an important consideration when selecting the surgical approach to the lesion. We addressed a recurrent intracavernous sinus dermoid cyst by the endoscopic endonasal transsphenoidal approach assisted by neuronavigation and indocyanine green (ICG) endoscopy to confirm the ICA and patency of the cavernous sinus. The ICG endoscope detected the fluorescence signal from the ICA and cavernous sinus; its intensity changed with the passage of time. The ICG endoscope was very useful for real-time imaging, and its high spatial resolution facilitated the detection of the ICA and the patent cavernous sinus. We found it to be of great value for successful endonasal transsphenoidal surgery.
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Affiliation(s)
- Takuichiro Hide
- Department of Neurosurgery, Kumamoto University Graduate School of Medical Science
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Indocyanine green videoangiography methodological variations: review. Neurosurg Rev 2014; 38:49-57; discussion 57. [PMID: 25171963 DOI: 10.1007/s10143-014-0570-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/22/2014] [Accepted: 07/22/2014] [Indexed: 12/22/2022]
Abstract
Indocyanine green videoangiography (ICGVA) procedures have become widespread within the spectrum of microsurgical techniques for neurovascular pathologies. We have conducted a review to identify and assess the impact of all of the methodological variations of conventional ICGVA applied in the field of neurovascular pathology that have been published to date in the English literature. A total of 18 studies were included in this review, identifying four primary methodological variants compared to conventional ICGVA: techniques based on the transient occlusion, intra-arterial ICG administration via catheters, use of endoscope system with a filter to collect florescence of ICG, and quantitative fluorescence analysis. These variants offer some possibilities for resolving the limitations of the conventional technique (first, the vascular structure to be analyzed must be exposed and second, vascular filling with ICG follows an additive pattern) and allow qualitatively superior information to be obtained during surgery. Advantages and disadvantages of each procedure are discussed. More case studies with a greater number of patients are needed to compare the different procedures with their gold standard, in order to establish these results consistently.
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