Intraoperative Fluorescent Visualization of Pituitary Adenomas - 28/08/19

Doi : 10.1016/j.nec.2019.05.002

Steve S. Cho, BS, John Y.K. Lee, MD, MSCE ^⁎
Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania Hospital, 801 Spruce Street, 8th Floor, Philadelphia, PA, 19107, USA

^∗Corresponding author.

Résumé

Tumor recurrence in pituitary adenomas is as high as 20% after surgery. Conventional neuronavigation and white light visualization are not sufficiently accurate in detecting residual neoplastic tissue. Fluorescence-guided surgery offers accurate, real-time visualization of neoplastic tissue. The authors’ group has explored the use of near-infrared imaging, which is superior to visible-light fluorescence in both signal contrast and tissue penetration, in transsphenoidal endoscopic surgeries for pituitary adenomas using 2 techniques: second window indocyanine green, in which indocyanine green passively accumulates in the tumor, and OTL38, which actively targets folate receptors on adenoma cells. This work establishes the foundation of intraoperative near-infrared imaging for fluorescence-guided neurosurgery.

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Keywords : Near-infrared fluorescence, Fluorescence-guided surgery, Second window indocyanine green, SWIG, OTL38, Pituitary adenomas

Plan

Key points

Introduction

Indications/contraindications

Surgical technique/procedure

Preoperative Planning

Preparation and Patient Positioning/Surgical Approach

Equipment

Visualization Technique

Surgical Procedure

Complications and management

Postoperative care

Outcomes

Summary

Disclosure Statement: S.S. Cho has nothing to disclose. J.Y.K. Lee owns stock options in Visionsense, which manufactures the endoscopes used for the research presented here. Supported in part by the National Institutes of Health R01 CA193556 (SS), and the Institute for Translational Medicine and Therapeutics of the Perelman School of Medicine at the University of Pennsylvania (JYKL). In addition, research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000003 (JKYL). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.