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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

Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view in Case 1. (a) Preoperative coronal Gd-enhanced MRI in Case 1 showing a pituitary tumor with extensive invasion into the sphenoidal sinus. (b) Preoperative 3D-CT and MRI fusion model demonstrating that bilateral ICAs (C3 and C4 portions) are buried in the invasive tumor at the anterior plane of the sella (inset) (stars: C4; asterisks: C3). (c) Endoscopic view before tumor resection showing the massive tumor that widely protruded into the sphenoidal sinus. (d) A neuronavigation system demonstrating the locations of the ICAs and the destroyed sella in the endoscopic view (c). CT images on the navigation display show the position of the chip and trajectory of the flexible probe that was placed on the marked position (black arrow) on the endoscopic view (c). (e) Endoscopic view after resection of the tumor showing the widely eroded sellar floor occupied with residual intrasellar tumor and intact bony structures over the ICAs (arrowheads: eroded sellar floor; CP: ICA prominence). T: tumor; the area of white-dashed line: endoscopic view in (c).
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fig2: Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view in Case 1. (a) Preoperative coronal Gd-enhanced MRI in Case 1 showing a pituitary tumor with extensive invasion into the sphenoidal sinus. (b) Preoperative 3D-CT and MRI fusion model demonstrating that bilateral ICAs (C3 and C4 portions) are buried in the invasive tumor at the anterior plane of the sella (inset) (stars: C4; asterisks: C3). (c) Endoscopic view before tumor resection showing the massive tumor that widely protruded into the sphenoidal sinus. (d) A neuronavigation system demonstrating the locations of the ICAs and the destroyed sella in the endoscopic view (c). CT images on the navigation display show the position of the chip and trajectory of the flexible probe that was placed on the marked position (black arrow) on the endoscopic view (c). (e) Endoscopic view after resection of the tumor showing the widely eroded sellar floor occupied with residual intrasellar tumor and intact bony structures over the ICAs (arrowheads: eroded sellar floor; CP: ICA prominence). T: tumor; the area of white-dashed line: endoscopic view in (c).

Mentions: Case 1. A 49-year-old woman was diagnosed with a growth hormone producing pituitary adenoma 3 years before and she had been treated with an intramuscular injection of octreotide. However, she suffered from persistent nasal congestion and sleep apnea syndrome. Gadolinium- (Gd-) enhanced MRI showed a macroadenoma with inferior extension into the sphenoidal sinus. The sellar floor had been destroyed by the invasive tumor and the bilateral ICAs from the C3 to the C5 portions were completely encased by the tumor (Figure 2(a)). We created the fusion model to make a preoperative plan for how to resect the tumor effectively and safely because it was difficult to identify the exact locations of the ICAs that were buried in the tumor with the 3D-CT model alone. Successive elimination of bony structures on the fusion image of 3D-CT and MRI clearly revealed the location of the bilateral ICAs surrounded by infiltrating tumor (Figure 2(b)). The intraoperative endoscopic view correlated with the images on the fusion model, but the exact location of the ICAs could not be identified due to the widely protruding tumor mass (Figure 2(c)). Thus, the electromagnetic navigation system was used to identify the sellar structures, including the ICAs (Figure 2(d)). Finally, we were able to resect most of the tumor that had extended through the destroyed sellar floor (Figure 2(e)).


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)

Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view in Case 1. (a) Preoperative coronal Gd-enhanced MRI in Case 1 showing a pituitary tumor with extensive invasion into the sphenoidal sinus. (b) Preoperative 3D-CT and MRI fusion model demonstrating that bilateral ICAs (C3 and C4 portions) are buried in the invasive tumor at the anterior plane of the sella (inset) (stars: C4; asterisks: C3). (c) Endoscopic view before tumor resection showing the massive tumor that widely protruded into the sphenoidal sinus. (d) A neuronavigation system demonstrating the locations of the ICAs and the destroyed sella in the endoscopic view (c). CT images on the navigation display show the position of the chip and trajectory of the flexible probe that was placed on the marked position (black arrow) on the endoscopic view (c). (e) Endoscopic view after resection of the tumor showing the widely eroded sellar floor occupied with residual intrasellar tumor and intact bony structures over the ICAs (arrowheads: eroded sellar floor; CP: ICA prominence). T: tumor; the area of white-dashed line: endoscopic view in (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig2: Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view in Case 1. (a) Preoperative coronal Gd-enhanced MRI in Case 1 showing a pituitary tumor with extensive invasion into the sphenoidal sinus. (b) Preoperative 3D-CT and MRI fusion model demonstrating that bilateral ICAs (C3 and C4 portions) are buried in the invasive tumor at the anterior plane of the sella (inset) (stars: C4; asterisks: C3). (c) Endoscopic view before tumor resection showing the massive tumor that widely protruded into the sphenoidal sinus. (d) A neuronavigation system demonstrating the locations of the ICAs and the destroyed sella in the endoscopic view (c). CT images on the navigation display show the position of the chip and trajectory of the flexible probe that was placed on the marked position (black arrow) on the endoscopic view (c). (e) Endoscopic view after resection of the tumor showing the widely eroded sellar floor occupied with residual intrasellar tumor and intact bony structures over the ICAs (arrowheads: eroded sellar floor; CP: ICA prominence). T: tumor; the area of white-dashed line: endoscopic view in (c).
Mentions: Case 1. A 49-year-old woman was diagnosed with a growth hormone producing pituitary adenoma 3 years before and she had been treated with an intramuscular injection of octreotide. However, she suffered from persistent nasal congestion and sleep apnea syndrome. Gadolinium- (Gd-) enhanced MRI showed a macroadenoma with inferior extension into the sphenoidal sinus. The sellar floor had been destroyed by the invasive tumor and the bilateral ICAs from the C3 to the C5 portions were completely encased by the tumor (Figure 2(a)). We created the fusion model to make a preoperative plan for how to resect the tumor effectively and safely because it was difficult to identify the exact locations of the ICAs that were buried in the tumor with the 3D-CT model alone. Successive elimination of bony structures on the fusion image of 3D-CT and MRI clearly revealed the location of the bilateral ICAs surrounded by infiltrating tumor (Figure 2(b)). The intraoperative endoscopic view correlated with the images on the fusion model, but the exact location of the ICAs could not be identified due to the widely protruding tumor mass (Figure 2(c)). Thus, the electromagnetic navigation system was used to identify the sellar structures, including the ICAs (Figure 2(d)). Finally, we were able to resect most of the tumor that had extended through the destroyed sellar floor (Figure 2(e)).

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