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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.

Inoue A, Ohnishi T, Kohno S, Nishida N, Nakamura Y, Ohtsuka Y, Matsumoto S, Ohue S - Int J Endocrinol (2015)

Bottom Line: Methods.Results.Additionally, the ICG endoscope was a useful real-time monitoring tool for ETSS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.

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.

No MeSH data available.


Related in: MedlinePlus

An illustrative case showing images of a fusion model of 3D-CT and MRI and intraoperative ICG endoscopy along with the corresponding endoscopic views. (a) Gadolinium- (Gd-) enhanced magnetic resonance imaging (MRI) showing a pituitary adenoma with suprasellar extension (coronal section). (b) Preoperative simulated view of the endoscopic endonasal transsphenoidal approach produced by the fusion model of 3D-CT and MRI that show bony prominences of the internal carotid arteries (ICAs), optic canals, and pituitary tumor around the sellar floor. (c) Intraoperative endoscopic view showing bony structures around the sellar floor (unopened). (d) Intraoperative endoscopic view showing the intrasellar structures, mainly the descending diaphragma sellae (DS) with the normal pituitary gland after total resection of the tumor. (e) Indocyanine green (ICG) endoscope showing vital structures such as the ICAs (a view corresponding to (c)) and (f) ICG endoscope showing ICAs in the right cavernous sinus and a normal pituitary gland adhered to the DS (SF: sellar floor; TS: tuberculum sella; CI: clival indentation; CP: ICA prominence; stars: C4 portion of ICA; asterisks: C3 portion in the cavernous sinus; OC: optic canal; and T: tumor). (e) Before opening the sella; (f) after tumor resection.
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fig1: An illustrative case showing images of a fusion model of 3D-CT and MRI and intraoperative ICG endoscopy along with the corresponding endoscopic views. (a) Gadolinium- (Gd-) enhanced magnetic resonance imaging (MRI) showing a pituitary adenoma with suprasellar extension (coronal section). (b) Preoperative simulated view of the endoscopic endonasal transsphenoidal approach produced by the fusion model of 3D-CT and MRI that show bony prominences of the internal carotid arteries (ICAs), optic canals, and pituitary tumor around the sellar floor. (c) Intraoperative endoscopic view showing bony structures around the sellar floor (unopened). (d) Intraoperative endoscopic view showing the intrasellar structures, mainly the descending diaphragma sellae (DS) with the normal pituitary gland after total resection of the tumor. (e) Indocyanine green (ICG) endoscope showing vital structures such as the ICAs (a view corresponding to (c)) and (f) ICG endoscope showing ICAs in the right cavernous sinus and a normal pituitary gland adhered to the DS (SF: sellar floor; TS: tuberculum sella; CI: clival indentation; CP: ICA prominence; stars: C4 portion of ICA; asterisks: C3 portion in the cavernous sinus; OC: optic canal; and T: tumor). (e) Before opening the sella; (f) after tumor resection.

Mentions: We successfully created a fusion model of 3D-CT and MRI in all patients. In the model, critical structures such as the ICAs, optic canals, the pituitary gland, and the tumor were completely reconstructed, and their spatial relationships were better visualized by successively deleting adjacent bony structure images. The intraoperative anatomy was consistent with the preoperative simulation that had been made based on the fusion models (Figures 1(a) and 1(b)). However, two major issues can complicate visualization of the anatomical structures of the sphenoidal sinus: the presence of multiple Onodi (sphenoethmoidal) cells and an invasive tumor mass occupying the sphenoidal sinus. The former was observed in 6 patients (17.1%), and the latter was observed in 7 patients (20.0%). The models revealed the entire course (C3–C5) of the bilateral ICAs and the intracranial arteries by successively eliminating images of the sphenoidal bony structures from anterior to posterior, even if the ICAs were involved in the tumor. The optic prominences were also identified in all patients. Onodi cells were clearly recognized in the models. Furthermore, we clearly recognized the positional relationship between the ICAs and invasive tumor. The fusion model of 3D-CT and MRI was possible to be viewed in the operating room during surgery as multislice presentations on a computer monitor. The images of CT/MRI fusion model were not created to be utilized for neuronavigation system. Compared to 2D images and 3D-CT models alone, the fusion model had the advantage of presenting images that much more clearly delineated the anatomical relationships between the sella, the surrounding vital structures such as the ICAs and optic canals, and the extensive infiltrating tumor.


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.

Inoue A, Ohnishi T, Kohno S, Nishida N, Nakamura Y, Ohtsuka Y, Matsumoto S, Ohue S - Int J Endocrinol (2015)

An illustrative case showing images of a fusion model of 3D-CT and MRI and intraoperative ICG endoscopy along with the corresponding endoscopic views. (a) Gadolinium- (Gd-) enhanced magnetic resonance imaging (MRI) showing a pituitary adenoma with suprasellar extension (coronal section). (b) Preoperative simulated view of the endoscopic endonasal transsphenoidal approach produced by the fusion model of 3D-CT and MRI that show bony prominences of the internal carotid arteries (ICAs), optic canals, and pituitary tumor around the sellar floor. (c) Intraoperative endoscopic view showing bony structures around the sellar floor (unopened). (d) Intraoperative endoscopic view showing the intrasellar structures, mainly the descending diaphragma sellae (DS) with the normal pituitary gland after total resection of the tumor. (e) Indocyanine green (ICG) endoscope showing vital structures such as the ICAs (a view corresponding to (c)) and (f) ICG endoscope showing ICAs in the right cavernous sinus and a normal pituitary gland adhered to the DS (SF: sellar floor; TS: tuberculum sella; CI: clival indentation; CP: ICA prominence; stars: C4 portion of ICA; asterisks: C3 portion in the cavernous sinus; OC: optic canal; and T: tumor). (e) Before opening the sella; (f) after tumor resection.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4539066&req=5

fig1: An illustrative case showing images of a fusion model of 3D-CT and MRI and intraoperative ICG endoscopy along with the corresponding endoscopic views. (a) Gadolinium- (Gd-) enhanced magnetic resonance imaging (MRI) showing a pituitary adenoma with suprasellar extension (coronal section). (b) Preoperative simulated view of the endoscopic endonasal transsphenoidal approach produced by the fusion model of 3D-CT and MRI that show bony prominences of the internal carotid arteries (ICAs), optic canals, and pituitary tumor around the sellar floor. (c) Intraoperative endoscopic view showing bony structures around the sellar floor (unopened). (d) Intraoperative endoscopic view showing the intrasellar structures, mainly the descending diaphragma sellae (DS) with the normal pituitary gland after total resection of the tumor. (e) Indocyanine green (ICG) endoscope showing vital structures such as the ICAs (a view corresponding to (c)) and (f) ICG endoscope showing ICAs in the right cavernous sinus and a normal pituitary gland adhered to the DS (SF: sellar floor; TS: tuberculum sella; CI: clival indentation; CP: ICA prominence; stars: C4 portion of ICA; asterisks: C3 portion in the cavernous sinus; OC: optic canal; and T: tumor). (e) Before opening the sella; (f) after tumor resection.
Mentions: We successfully created a fusion model of 3D-CT and MRI in all patients. In the model, critical structures such as the ICAs, optic canals, the pituitary gland, and the tumor were completely reconstructed, and their spatial relationships were better visualized by successively deleting adjacent bony structure images. The intraoperative anatomy was consistent with the preoperative simulation that had been made based on the fusion models (Figures 1(a) and 1(b)). However, two major issues can complicate visualization of the anatomical structures of the sphenoidal sinus: the presence of multiple Onodi (sphenoethmoidal) cells and an invasive tumor mass occupying the sphenoidal sinus. The former was observed in 6 patients (17.1%), and the latter was observed in 7 patients (20.0%). The models revealed the entire course (C3–C5) of the bilateral ICAs and the intracranial arteries by successively eliminating images of the sphenoidal bony structures from anterior to posterior, even if the ICAs were involved in the tumor. The optic prominences were also identified in all patients. Onodi cells were clearly recognized in the models. Furthermore, we clearly recognized the positional relationship between the ICAs and invasive tumor. The fusion model of 3D-CT and MRI was possible to be viewed in the operating room during surgery as multislice presentations on a computer monitor. The images of CT/MRI fusion model were not created to be utilized for neuronavigation system. Compared to 2D images and 3D-CT models alone, the fusion model had the advantage of presenting images that much more clearly delineated the anatomical relationships between the sella, the surrounding vital structures such as the ICAs and optic canals, and the extensive infiltrating tumor.

Bottom Line: Methods.Results.Additionally, the ICG endoscope was a useful real-time monitoring tool for ETSS.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan.

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.

No MeSH data available.


Related in: MedlinePlus