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Inoue A, Watanabe H, Suehiro S, Nishida N, Shiraishi Y, Furumochi T, Takimoto Y, Ohnishi T, Shigekawa S, Kunieda T. Clinical utility of new bone imaging using zero-echo-time sequence in neurosurgical procedures: Can zero-echo-time be used in clinical practice in neurosurgery? Neuroradiol J 2023; 36:289-296. [PMID: 37259240 PMCID: PMC10268098 DOI: 10.1177/19714009221114447] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the clinical usefulness of zero-echo-time (ZTE)-based magnetic resonance imaging (MRI) in planning the optimum surgical approach and applying ZTE for anatomical guidance during transcranial surgery. METHODS Eleven of 26 patients who underwent transcranial surgery and carotid endarterectomy and in whom ZTE-based MRI and magnetic resonance angiography (MRA) data were obtained were analyzed by creating ZTE/MRA fusion images and 3D ZTE-based MRI models. We examined whether these images and models can be substituted for computed tomography imaging for neurosurgical procedures. Furthermore, the clinical usability of the 3D ZTE-based MRI models was evaluated by comparing them with actual surgical views. RESULTS Zero-echo-time/MRA fusion images and 3D ZTE-based MRI models clearly illustrated the cranial and intracranial morphology without radiation exposure or the use of iodinated contrast medium. The models allowed determination of the optimum surgical approach to cerebral aneurysms, brain tumors near the brain surface, and cervical internal carotid artery stenosis by visualizing the relationship of lesions with adjacent bone structures. However, ZTE-based MRI did not provide useful information for surgery for skull base lesions such as vestibular schwannoma because bone structures of the skull base often include air components, which cause signal disturbance in MRI. CONCLUSIONS Zero-echo-time sequences on MRI allowed distinct visualization of not only bone but also vital structures around the lesion. This technology has low invasiveness for patients and was useful for preoperative planning and guidance of the optimum approach during surgery in a subset of neurosurgical diseases.
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Affiliation(s)
- Akihiro Inoue
- Department of Neurosurgery, Ehime University School of
Medicine, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University School of
Medicine, Japan
| | - Satoshi Suehiro
- Department of Neurosurgery, Ehime University School of
Medicine, Japan
| | - Naoya Nishida
- Department of Otolaryngology, Ehime University School of
Medicine, Japan
| | | | | | | | | | - Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of
Medicine, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of
Medicine, Japan
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The Role of Intraoperative Indocyanine Green (ICG) and Preoperative 3-Dimensional (3D) Reconstruction in Laparoscopic Adrenalectomy: A Propensity Score-matched Analysis. Surg Laparosc Endosc Percutan Tech 2022; 32:643-649. [PMID: 36468889 PMCID: PMC9719832 DOI: 10.1097/sle.0000000000001105] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic adrenalectomy (LA) is considered the "gold standard" treatment of adrenal lesions that are often coincidentally diagnosed during the radiologic workup of other diseases. This study aims to evaluate the intraoperative role of indocyanine green (ICG) fluorescence associated with preoperative 3-dimensional reconstruction (3DR) in laparoscopic adrenalectomy in terms of perioperative outcomes. To our knowledge, this is the first prospective case-controlled report comparing these techniques. MATERIALS AND METHODS All consecutive patients aged≥18 and undergoing laparoscopic transperitoneal adrenalectomy for all adrenal masses from January 1, 2019 to January 31, 2022 were prospectively enrolled. Patients undertaking standard LA and those undergoing preoperative 3D reconstruction and intraoperative ICG fluorescence were matched through a one-on-one propensity score matching analysis (PSM) for age, gender, BMI, CCI score, ASA score, lesion histology, tumor side, and lesion diameter. Differences in operative time, blood loss, intraoperative and postoperative complications, conversion rate, and length of stay were analyzed. RESULTS After propensity score matching analysis, we obtained a cohort of 36 patients divided into 2 groups of 18 patients each. The operative time and intraoperative blood loss were shorter in patients of the 3DR group ( P =0,004 and P =0,004, respectively). There was no difference in terms of length of stay, conversion rate, and intraoperative and postoperative complications between the 2 groups. CONCLUSIONS The use of intraoperative ICG in LA and preoperative planning with 3DR images is a safe and useful addition to surgery. Furthermore, we observed a reduction in terms of operating time and intraoperative blood loss.
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Indocyanine Green Endoscopy for Pituitary Adenomas with Parasellar Extension: Results from a Preliminary Case Series. World Neurosurg 2022; 166:e692-e702. [PMID: 35917924 DOI: 10.1016/j.wneu.2022.07.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Advances in visualization tools have brought new confidence, including endoscope-integrated indocyanine (E-ICG), which makes pituitary and skull-base surgery safer and more effective. We report here our preliminary experience with the use of E-ICG to 1) visualize the cavernous segment of the internal carotid artery (ICA); and 2) functionally and anatomically preserve the pituitary gland. METHODS A dedicated ICG-integrated endoscope was used in 15 patients with parasellar pituitary adenomas. Indocyanine was administered at 2 different time points during surgery: an early bolus of 12.5 mg at the sphenoid sinus opening to expose the position of the parasellar segment of the ICAs and to identify the position of the normal pituitary gland so that it could be preserved during tumor removal. Subsequently, a second late bolus of 12 mg of ICG was injected to obtain a real-time "wire angiographic" visualization of the flow of the ICAs. RESULTS Gross total resection was achieved in 12 cases (80%), whereas subtotal resection was performed in the other 3 cases (20%). The pituitary gland was clearly discernable in 11 cases (91.6%). None of the patients manifested new endocrinologic deficits or major vascular complications. CONCLUSIONS E-ICG is a safe and essential aid for pituitary adenomas invading the cavernous sinus. Its performance as a pituitary marker and real-time video angiography showed promising results in terms of extent of resection, endocrinologic outcomes, and prevention of intraoperative complications.
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Fluorescence-guided radical prostatectomy. Int Urol Nephrol 2022; 54:2775-2781. [PMID: 35904680 DOI: 10.1007/s11255-022-03307-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/09/2022] [Indexed: 10/16/2022]
Abstract
Robotic-assisted laparoscopic radical prostatectomy represents one of the most common operations in urologic oncology and involves several critical technical steps including pelvic lymph node dissection, cavernous nerve sparing and vesicourethral anastomosis. The quality of performing these steps is linked to functional and oncological outcomes. Indocyanine green [ICG] is a non-radioactive, water-soluble compound which allows for enhanced visualization with near-infrared fluorescence of both anatomical structures and vasculature during complex abdominal operations such as prostatectomy. During the last decade, several investigators have examined the value and role of ICG fluorescence during prostatectomy. In this review, we sought to evaluate the body of evidence for fluorescence-guided robotic prostatectomy as well as assess potential future areas of investigation with this technology.
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Lee MH, Lee TK. Application of fusion-fluorescence imaging using indocyanine green in endoscopic endonasal surgery. J Clin Neurosci 2022; 98:45-52. [DOI: 10.1016/j.jocn.2022.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/04/2022] [Accepted: 01/21/2022] [Indexed: 12/30/2022]
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Zhang Y, Tu S, Duan L, Fu W, Wang J, Geng S. Classification of Pituitary Adenomas Invading the Cavernous Sinus Assisted by Three-Dimensional Multimodal Imaging and Its Clinical Application. J Neurol Surg B Skull Base 2021; 82:567-575. [PMID: 34513564 DOI: 10.1055/s-0040-1715597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 06/21/2020] [Indexed: 10/23/2022] Open
Abstract
Introduction To help diagnose and evaluate the prognosis of pituitary adenoma with cavernous sinus (CS) invasion and guide endonasal endoscopic surgery (EES) assisted by intraoperative navigation (ION) with three-dimensional multimodal imaging (3D-MMI). We propose a classification of CS invasion based on 3D-MMI. Methods We picked some appropriate cases and reconstructed the 3D-MMI and then classified them into 3 grades according to the stereo relationship among ICA, tumor and CS in 3D-MMI. Then, we applied different strategies according to their grade to remove pituitary adenomas that invaded the CS. Results All 38 patients were divided into 3 grades. Tumors compressing the ICA and CS without CS invasion were divided into grade 1. Tumors encasing the ICA and invading the superior-posterior compartment and/or anterior-inferior compartment but without distinct separation of the ICA and CS lateral wall were deemed as grade 2. Tumors encasing the ICA and filling the lateral compartment of the CS that dissociated the lateral wall from the ICA were deemed as grade 3. The 3D-MMI enabled adequate spatial visualization of the ICA, CS and tumors. All patients were operated on under the guidance of ION with 3D-MMI. Conclusion Classification based on 3D-MMI can better demonstrate the relationships among tumor, ICA and CS in a stereo and multi-angle view, which will have significance in guiding the surgical strategy.
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Affiliation(s)
- Yukun Zhang
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Shaohua Tu
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lian Duan
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Weilun Fu
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jianbo Wang
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Sumin Geng
- Department of Neurosurgery, Capital Medical University, Beijing Tiantan Hospital, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
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Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal. Brain Sci 2021; 11:brainsci11050565. [PMID: 33925235 PMCID: PMC8146254 DOI: 10.3390/brainsci11050565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: Despite many surgical and technological advances, pituitary adenoma surgery is still burdened by non-negligible rates of incomplete tumor resection, mainly due to difficulties in differentiating pathology from normal pituitary tissue. Some fluorescent agents have been recently investigated as intraoperative contrast agents in pituitary surgery. The aim of this study is to evaluate the actual knowledge about the usefulness of such fluorophores with a particular focus on both the pharmacokinetics and pharmacodynamics issues of the pituitary gland. (2) Methods: We reviewed the current literature about fluorophores use in pituitary surgery and reported the first fully endoscopic experience with fluorescein. (3) Results: The studies investigating 5-ALA use reported contrasting results. ICG showed encouraging results, although with some specificity issues in identifying pathological tissue. Low-dose fluorescein showed promising results in differentiating pathology from normal pituitary tissue. Apart from the dose and timing of administration, both the fluorophores' volume of distribution and the histological variability of the interstitial space and vascular density played a crucial role in optimizing intraoperative contrast enhancement. (4) Conclusions: Both pharmacokinetics and pharmacodynamics issues determine the potential usefulness of fluorophores in pituitary surgery. ICG and fluorescein showed the most promising results, although further studies are needed.
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Shahein M, Prevedello DM, Beaumont TL, Ismail K, Nouby R, Palettas M, Prevedello LM, Otto BA, Carrau RL. The role of indocyanine green fluorescence in endoscopic endonasal skull base surgery and its imaging correlations. J Neurosurg 2020; 135:923-933. [PMID: 33186906 DOI: 10.3171/2020.6.jns192775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of endoscope-integrated indocyanine green (E-ICG) has recently been introduced in skull base surgery. The quantitative correlation between E-ICG and T1-weighted gadolinium-enhanced (T1WGd) images for skull base tumors has not been previously assessed, to the authors' knowledge. In this study, the authors investigated the indications for use and the limitations of E-ICG and sought to correlate the endoscopic fluorescence pattern with MRI contrast enhancement. METHODS Following IRB approval, 20 patients undergoing endoscopic endonasal skull base surgery between June 2017 and August 2018 were enrolled in the study. Tumor fluorescence was measured using a blue color value and blood fluorescence as a control. Signal intensities (SIs) of tumor T1WGd images were measured and the internal carotid artery (ICA) SI was used as a control. For pituitary adenoma, the pituitary gland fluorescence was also measured. The relationships between ICG fluorescence and MRI enhancement measurements were analyzed. RESULTS Data showed that in pituitary adenoma there was a strong correlation between the ratios of gland/blood fluorescence to gland/ICA SI (n = 8; r = 0.92; p = 0.001) and tumor/blood fluorescence to tumor/ICA SI (n = 9; r = 0.82; p = 0.006). In other pathologies there was a strong correlation between the ratios of tumor/blood fluorescence and tumor/ICA SI (n = 9; r = 0.74; p = 0.022). The ICG fluorescence allowed perfusion assessment of the pituitary gland as well as of the nasoseptal flaps. Visualization of the surrounding vasculature was also feasible. CONCLUSIONS Defining the indications and understanding the limitations are critical for the effective use of E-ICG. Tumor fluorescence seems to correlate with preoperative MRI contrast enhancement.
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Affiliation(s)
- Mostafa Shahein
- Departments of1Neurological Surgery
- 3Department of Neurosurgery, Aswan University Hospitals, Aswan University, Aswan, Egypt
| | | | | | - Khalid Ismail
- 3Department of Neurosurgery, Aswan University Hospitals, Aswan University, Aswan, Egypt
| | - Radwan Nouby
- 3Department of Neurosurgery, Aswan University Hospitals, Aswan University, Aswan, Egypt
| | | | - Luciano M Prevedello
- 5Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio; and
| | - Bradley A Otto
- Departments of1Neurological Surgery
- 2Otolaryngology-Head and Neck Surgery
| | - Ricardo L Carrau
- Departments of1Neurological Surgery
- 2Otolaryngology-Head and Neck Surgery
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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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Clinical utility of new three-dimensional model using a zero-echo-time sequence in endoscopic endonasal transsphenoidal surgery. Clin Neurol Neurosurg 2020; 190:105743. [PMID: 32113079 DOI: 10.1016/j.clineuro.2020.105743] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/11/2020] [Accepted: 02/16/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Recognizing the anatomical orientation surrounding the sellar floor is crucial in endoscopic endonasal transsphenoidal surgery (ETSS). Zero-echo-time (ZTE) sequences were recently suggested for a new bone identification technique on magnetic resonance imaging (MRI). This study aimed to evaluate the clinical usefulness of three-dimensional (3D)-ZTE-based MRI models in providing anatomical guidance for ETSS. PATIENTS AND METHODS ZTE-based MRI and magnetic resonance angiography (MRA) data from 15 consecutive patients with pituitary tumor treated between September 2018 and May 2019 were used to create 3D-MRI models. From these, the architecture surrounding the sellar floor, particularly anatomical relationships between tumors and internal carotid arteries (ICAs), was visualized to preoperatively plan surgical procedures. In addition, 3D-ZTE-based MRI models were compared to actual surgical views during ETSS to evaluate model applicability. RESULTS These 3D-ZTE-based MRI models clearly demonstrated the morphology of the sellar floor and matched well with intraoperative views, including pituitary tumor, by successively eliminating sphenoidal structures. The models also permitted determination of the maximum marginal line of the opening of the sellar floor by presenting vital structures such as ICAs and tumors. With such 3D-MRI models, the surgeon could access the intracranial area through the sellar floor more safely, and resect the pituitary tumor maximally without complications. CONCLUSION Our 3D-MRI models based on ZTE sequences allowed distinct visualization of vital structures and pituitary tumor around the sellar floor. This new method using 3D-ZTE-based MRI models showed low invasiveness for patients and was useful in preoperative planning for ETSS, facilitating maximum tumor resection without complications.
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Durastanti G, Leardini A, Siegler S, Durante S, Bazzocchi A, Belvedere C. Comparison of cartilage and bone morphological models of the ankle joint derived from different medical imaging technologies. Quant Imaging Med Surg 2019; 9:1368-1382. [PMID: 31559166 DOI: 10.21037/qims.2019.08.08] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Accurate geometrical models of bones and cartilage are necessary in biomechanical modelling of human joints, and in planning and designing of joint replacements. Image-based subject-specific model development requires image segmentation, spatial filtering and 3-dimensional rendering. This is usually based on computed tomography (CT) for bone models, on magnetic resonance imaging (MRI) for cartilage models. This process has been reported extensively in the past, but no studies have ever compared the accuracy and quality of these models when obtained also by merging different imaging modalities. The scope of the present work is to provide this comparative analysis in order to identify optimal imaging modality and registration techniques for producing 3-dimensional bone and cartilage models of the ankle joint. Methods One cadaveric leg was instrumented with multimodal markers and scanned using five different imaging modalities: a standard, a dual-energy and a cone-beam CT (CBCT) device, and a 1.5 and 3.0 Tesla MRI devices. Bone, cartilage, and combined bone and cartilage models were produced from each of these imaging modalities, and registered in space according to matching model surfaces or to corresponding marker centres. To assess the quality in overall model reconstruction, distance map analyses were performed and the difference between model surfaces obtained from the different imaging modalities and registration techniques was measured. Results The registration between models worked better with model surface matching than corresponding marker positions, particularly with MRI. The best bone models were obtained with the CBCT. Models with cartilage were defined better with the 3.0 Tesla than the 1.5 Tesla. For the combined bone and cartilage models, the colour maps and the numerical results from distance map analysis (DMA) showed that the smallest distances and the largest homogeneity were obtained from the CBCT and the 3.0 T MRI via model surface registration. Conclusions These observations are important in producing accurate bone and cartilage models from medical imaging and relevant for applications such as designing of custom-made ankle replacements or, more in general, of implants for total as well as focal joint replacements.
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Affiliation(s)
- Gilda Durastanti
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Sorin Siegler
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA, USA
| | - Stefano Durante
- Nursing, Technical and Rehabilitation Assistance Service, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Du J, Li W, Tan H. Three-Layer Image Representation by an Enhanced Illumination-Based Image Fusion Method. IEEE J Biomed Health Inform 2019; 24:1169-1179. [PMID: 31352358 DOI: 10.1109/jbhi.2019.2930978] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The recently developed multiscale-based fusion methods can be improved with two approaches: an advanced image decomposition scheme and an advanced fusion rule. In this paper, three-layer image decomposition, enhanced illumination fusion rule-based method is proposed. The proposed method includes three steps. First, each input image is decomposed into its corresponding smooth, texture, and edge layers using defined local extrema and low-pass filters in the spatial domain. Second, three different strategies are applied as fusion rules for the three-layer representation. To preserve the illumination closely related to tumors, the illumination is corrected by applying a higher contrast to the decomposed image details, including the texture and edge inputs, such as those found in grayscale CT and MRI images. The final fused image is created by the addition of the normalized smooth, texture, and edge image layers. The experiments demonstrate that the proposed method performs better than the existing state-of-the-art fusion methods.
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Hirano T, Ichikawa K, Wanibuchi M, Mikami T, Suzuki J, Nagahama H, Mikuni N. Accuracy of computed tomography-magnetic resonance imaging image fusion using a phantom for skull base surgery. J Neurosurg Sci 2019; 66:9-16. [PMID: 30808859 DOI: 10.23736/s0390-5616.19.04621-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To assess the positional accuracy of image fusions of the skull base region using different magnetic resonance imaging (MRI) and computed tomography (CT) image pairs. METHODS An image set of 3D fast imaging employing steady-state acquisition-C (FIESTA-C) was used as the base image set. Image fusions were performed using an image set with different fields of view (FOVs): one with different matrix size, one with a different sequence of 3D spoiled gradient recalled acquisition, and one with different modality (CT), using a phantom including multi columnar objects. Position of columns at the center, and 4 and 8 cm from the center were measured. The displacements between the base image set and fused image set were measured. For slices with different z-positions, the displacement of the 8-cm column was assessed. For 20 clinical MRI cases, the distance between the dorsum sellae and the cranial nerves was measured. RESULTS No significant differences were found between the different FOVs or image sequences. However, with the different matrix sizes and modalities, significant displacements were observed, although they were all within 0.5 mm. Similar displacements were observed in the slices at different z-positions. All cranial nerves were located within 40 mm of the dorsum sellae. CONCLUSIONS The displacements following image fusion were within approximately 0.5 mm, even at 8 cm from the center. This suggests that the region where the cranial nerves are located, within 40 mm of the dorsum sellae, had no risk of positional error following image fusion.
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Affiliation(s)
- Toru Hirano
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan -
| | - Katsuhiro Ichikawa
- Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Sapporo, Hokkaido, Japan
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Junpei Suzuki
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Hiroshi Nagahama
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Zhang P, Wang G, Sun Z, Lv X, Guo Y, Wang J, Wu Y, Shi W, Zhang H, Liu H, Lu Y. Application of Multimodal Image Fusion to Precisely Localize Small Intramedullary Spinal Cord Tumors. World Neurosurg 2018; 118:246-249. [PMID: 30031956 DOI: 10.1016/j.wneu.2018.07.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to study the application of precise intraoperative localization of small intramedullary spinal cord tumors. METHODS From November 2015 to August 2017, 5 patients with small intramedullary spinal cord tumors were arranged in this group. By using the O-arm image system, we acquired the intraoperative computed tomography images of all patients and sent them to the Stealth navigation system. Medtronic Synergy Cranial software was used to complete the image fusion with preoperative magnetic resonance images, and the fused images were used to localize the intramedullary spinal cord tumors by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the tumor in sagittal magnetic resonance imaging and its real position. RESULTS Five patients accomplished the multimodal image fusion, and we successfully completed the image-guided surgeries. The mean diameter of tumors was 12.2 ± 3.1 mm in sagittal magnetic resonance imaging, and the mean incision length was 12.7 ± 3.3 mm. The time of image processing was between 13 minutes and 17 minutes, and the mean value was 15 ± 1.6 minutes. The navigation error was between 0.9 mm and 1.5 mm, and the mean value was 1.2 ± 0.2 mm. CONCLUSIONS The application of the multimodal image fusion combined with intraoperative O-arm image navigation system can be used to localize small intramedullary tumors.
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Affiliation(s)
- Peihai Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Guihuai Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
| | - Zhenxing Sun
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yi Guo
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - James Wang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Youtu Wu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Wei Shi
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Huifang Zhang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Huiting Liu
- Peking Union Medical University Hospital, Beijing, China
| | - Yang Lu
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Yuzhakova DV, Lermontova SA, Grigoryev IS, Muravieva MS, Gavrina AI, Shirmanova MV, Balalaeva IV, Klapshina LG, Zagaynova EV. In vivo multimodal tumor imaging and photodynamic therapy with novel theranostic agents based on the porphyrazine framework-chelated gadolinium (III) cation. Biochim Biophys Acta Gen Subj 2017; 1861:3120-3130. [PMID: 28916141 DOI: 10.1016/j.bbagen.2017.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND A promising strategy for cancer diagnosis and therapy is the development of an agent for multimodal imaging and treatment. In the present paper we report on two novel multifunctional agents prepared on the porphyrazine pigment platform using a gadolinium (III) cation chelated by red-fluorescent tetrapyrrole macrocycles (GdPz1 and GdPz2). METHODS Spectral and magnetic properties of the compounds were analyzed. Monitoring of GdPz1 and GdPz2 accumulation in the murine colon carcinoma CT26 was performed in vivo using fluorescence imaging and MRI. The photobleaching of GdPz1 or GdPz2 and tumor growth rate after photodynamic therapy (PDT) were assessed. RESULTS GdPz1 and GdPz2 demonstrated the selective accumulation in tumor that was indicated by higher fluorescence intensity in the tumor area in comparison with the normal tissues. The results of MRI in vivo showed that GdPz1 or GdPz2 provided significant contrast enhancement of the tumor in T1 MR images. PDT with GdPz2 resulted in ~20% decrease in fluorescence intensity of the compound and the inhibition of tumor growth. CONCLUSIONS We assessed the efficiency of two innovative Gd(III) cation-porphyrazine chelates as bimodal MR and fluorescent probes and photosensitizers for PDT and showed their potentials for tumor diagnostics and treatment. GENERAL SIGNIFICANCE Water-soluble structures simple in preparation and administration into the body represent special interest for theranostics of tumors. Novel porphyrazine macrocycles chelating a central gadolinium cation demonstrated a good prospect as effective multimodal agents, representing a new approach to MRI and fluorescence imaging guided PDT.
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Affiliation(s)
- Diana V Yuzhakova
- Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia; Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia.
| | - Svetlana A Lermontova
- Razuvaev Institute of Organometallic, Chemistry of the Russian, Academy of Sciences, 49 Tropinina St., 603950 Nizhny Novgorod, Russia; Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Ilya S Grigoryev
- Razuvaev Institute of Organometallic, Chemistry of the Russian, Academy of Sciences, 49 Tropinina St., 603950 Nizhny Novgorod, Russia
| | - Maria S Muravieva
- Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Alena I Gavrina
- Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia; Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Marina V Shirmanova
- Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia
| | - Irina V Balalaeva
- Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Larisa G Klapshina
- Razuvaev Institute of Organometallic, Chemistry of the Russian, Academy of Sciences, 49 Tropinina St., 603950 Nizhny Novgorod, Russia; Lobachevsky State University of Nizhny Novgorod, 23 Gagarin Ave., 603950 Nizhny Novgorod, Russia
| | - Elena V Zagaynova
- Nizhny Novgorod State Medical Academy, 10/1 Minin and Pozharsky Sq., 603005 Nizhny Novgorod, Russia
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16
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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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Belykh E, Martirosyan NL, Yagmurlu K, Miller EJ, Eschbacher JM, Izadyyazdanabadi M, Bardonova LA, Byvaltsev VA, Nakaji P, Preul MC. Intraoperative Fluorescence Imaging for Personalized Brain Tumor Resection: Current State and Future Directions. Front Surg 2016; 3:55. [PMID: 27800481 PMCID: PMC5066076 DOI: 10.3389/fsurg.2016.00055] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Fluorescence-guided surgery is one of the rapidly emerging methods of surgical "theranostics." In this review, we summarize current fluorescence techniques used in neurosurgical practice for brain tumor patients as well as future applications of recent laboratory and translational studies. METHODS Review of the literature. RESULTS A wide spectrum of fluorophores that have been tested for brain surgery is reviewed. Beginning with a fluorescein sodium application in 1948 by Moore, fluorescence-guided brain tumor surgery is either routinely applied in some centers or is under active study in clinical trials. Besides the trinity of commonly used drugs (fluorescein sodium, 5-aminolevulinic acid, and indocyanine green), less studied fluorescent stains, such as tetracyclines, cancer-selective alkylphosphocholine analogs, cresyl violet, acridine orange, and acriflavine, can be used for rapid tumor detection and pathological tissue examination. Other emerging agents, such as activity-based probes and targeted molecular probes that can provide biomolecular specificity for surgical visualization and treatment, are reviewed. Furthermore, we review available engineering and optical solutions for fluorescent surgical visualization. Instruments for fluorescent-guided surgery are divided into wide-field imaging systems and hand-held probes. Recent advancements in quantitative fluorescence-guided surgery are discussed. CONCLUSION We are standing on the threshold of the era of marker-assisted tumor management. Innovations in the fields of surgical optics, computer image analysis, and molecular bioengineering are advancing fluorescence-guided tumor resection paradigms, leading to cell-level approaches to visualization and resection of brain tumors.
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Affiliation(s)
- Evgenii Belykh
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Nikolay L. Martirosyan
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Kaan Yagmurlu
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Eric J. Miller
- University of Arizona College of Medicine – Phoenix, Phoenix, AZ, USA
| | - Jennifer M. Eschbacher
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mohammadhassan Izadyyazdanabadi
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- School of Life Sciences, Arizona State University, Tempe, AZ, USA
| | - Liudmila A. Bardonova
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Vadim A. Byvaltsev
- Laboratory of Neurosurgery, Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk, Russia
- Irkutsk State Medical University, Irkutsk, Russia
| | - Peter Nakaji
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Mark C. Preul
- Department of Neurosurgery, St. Joseph’s Hospital and Medical Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Schmidt F, Dittberner A, Koscielny S, Petersen I, Guntinas-Lichius O. Feasibility of real-time near-infrared indocyanine green fluorescence endoscopy for the evaluation of mucosal head and neck lesions. Head Neck 2016; 39:234-240. [PMID: 27590351 PMCID: PMC5248641 DOI: 10.1002/hed.24570] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 07/02/2016] [Accepted: 07/22/2016] [Indexed: 01/21/2023] Open
Abstract
Background The purpose of this study was to explore the feasibility and potential drawbacks of near‐infrared (NIR) endoscopy with indocyanine green (ICG) to examine mucosal head and neck lesions. Methods NIR ICG endoscopy was applied to image head and neck cancer epithelium in vivo. The evaluation of the ICG videos was performed off‐line independently by 2 evaluators and blinded with respect to final histopathological results from biopsies taken as the gold standard. Results Forty percent of the lesions from 55 patients were histologically malignant. ICG positivity showed a sensitivity, specificity, and accuracy to be related to a malignant tumor of 90.5%, 90.9%, and 89.1%, respectively. The kappa index for the interobserver assessment showed a 94.4% agreement for the assessment of the ICG positivity. Side effects of the NIR ICG endoscopy did not arise. Conclusion NIR ICG endoscopy in patients with mucosal head and neck lesions was feasible and safe. It might help intraoperatively to differentiate benign from malignant lesions. © 2016 Wiley Periodicals, Inc. Head Neck39: 234–240, 2017
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Affiliation(s)
- Florian Schmidt
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany.,Department of Otorhinolaryngology, Head and Neck Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Sven Koscielny
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Jena University Hospital, Jena, Germany
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Catapano G, de Notaris M, Di Maria D, Fernandez LA, Di Nuzzo G, Seneca V, Iorio G, Dallan I. The use of a three-dimensional endoscope for different skull base tumors: results of a preliminary extended endonasal surgical series. Acta Neurochir (Wien) 2016; 158:1605-16. [PMID: 27278644 DOI: 10.1007/s00701-016-2847-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evolution of skull base surgery over the past decade has been influenced by advancement in visualization technology. Recently, as a result of such improvements, three-dimensional (3-D) scopes have been widely used during endoscopic endonasal approaches. In the present study, we describe the use of 3-D stereoscopic endoscope for the treatment of a variety of skull base lesions. METHODS From January 2010 to June 2015, a 3-D endoscopic endonasal approach (4 and 4.9 mm, 0°, and 30° rigid endoscopes) was performed in 70 patients with the following lesions: 42 large extrasellar pituitary macroadenomas, seven tuberculum sellae meningiomas, seven clivus chordomas, five craniopharyngiomas, three fibrous dysplasia of the clivus, three sinonasal malignancies, one orbital lymphangioma, one trigeminal neurinoma, one primary suprasellar lymphoma. RESULTS Total tumor removal was obtained in 50 patients (71.4 %) while in 14 (20 %), subtotal removal was possible in six (8.6 %) only partial removal was achieved. Overall complications included diabetes insipidus in eight patients (11.4 %), hypopituitarism in seven patients (10 %), CSF leak in five patients (7.1 %), cranial nerve injury in two patients (2.8 %), panhypopituitarism in two patients (2.8 %), meningitis in one (1.4 %) and one postoperative central retinal artery occlusion (1.4 %). There was no mortality in the series. The mean follow-up time was 39 months (range, 6-72 months). CONCLUSIONS In our experience, the 3-D endoscope represents a critical development in visualization, thus enabling improved hand-eye coordination and depth perception, which are mandatory for the management of complex intradural neurovascular structures during tumor removal surgery.
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Affiliation(s)
- Giuseppe Catapano
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy
| | - Matteo de Notaris
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy.
| | | | - Luis Alonso Fernandez
- Department of Neurosurgery, Centro Nacional de Cirugía de Mínimo Acceso, La Habana, Cuba
| | - Giuseppe Di Nuzzo
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy
| | - Vincenzo Seneca
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy
| | - Giuseppina Iorio
- Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Via Pacevecchia n.53, 82100, Benevento, Italy
| | - Iacopo Dallan
- Unit of Otorhinolaryngology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Role of Denosumab in Endoscopic Endonasal Treatment for Juvenile Clival Giant Cell Tumor: A Case Report and Review of the Literature. World Neurosurg 2016; 91:674.e1-6. [PMID: 27113403 DOI: 10.1016/j.wneu.2016.04.054] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/14/2016] [Accepted: 04/15/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Giant cell tumors (GCTs) are histologically benign bone neoplasms with a locally aggressive nature that primarily occur in the epiphyses of the long bones. A small proportion of these tumors, however, occur in the pelvis, spine, or skull bones. Among these, GCTs of the skull base cannot be completely resected and require adjuvant therapy. We report a juvenile case of clival GCT that was successfully treated by endoscopic endonasal transsphenoidal surgery and subsequent adjuvant therapy with denosumab, a monoclonal antibody to receptor activator of nuclear factor-κB ligand. CASE DESCRIPTION A 16-year-old boy was admitted to our hospital with progressively intolerable headache and right oculomotor nerve palsy. Computed tomography and magnetic resonance imaging showed a large tumor mass in the sphenoid sinus with extensive erosion of the clivus and compression of the right cavernous sinus. The tumor was resected by endonasal transsphenoidal surgery and histologically diagnosed as GCT. The giant cells showed positive immunostaining for CD68 and Mib-1 labeling index was less than 1.0%. Postoperative course was uneventful and the oculomotor disturbance was markedly improved. However, magnetic resonance imaging 2 weeks after surgery revealed marked enlargement of the tumor. Adjuvant therapy with denosumab was therefore initiated, resulting in marked reductions in tumor size. CONCLUSIONS This is the first report to describe beneficial effects of denosumab in the treatment of GCT of the skull base.
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