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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 and ICG fluorescence views in Case 3. (a, b) Preoperative coronal and sagittal Gd-enhanced MRI in Case 3 showing a pituitary tumor extending into the sphenoidal sinus with involvement of both ICAs by the tumor. (c) Preoperative 3D-CT and MRI fusion model revealing the relationship between the tumor and the vital structures such as the ICAs and optic nerves and the location of the ICAs (asterisks: C3; stars: C4) by eliminating bony structures. (d) Endoscopic view after decompression of the tumor showing residual tumor bilaterally with descending diaphragma sellae (DS) centrally. (e, f) ICG endoscopic views visualizing the right ICA (asterisk: C3; star: C4) under the tumor and the normal pituitary gland (PG) at the posterior part of the diaphragma sellae. T: tumor.
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fig4: Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view and ICG fluorescence views in Case 3. (a, b) Preoperative coronal and sagittal Gd-enhanced MRI in Case 3 showing a pituitary tumor extending into the sphenoidal sinus with involvement of both ICAs by the tumor. (c) Preoperative 3D-CT and MRI fusion model revealing the relationship between the tumor and the vital structures such as the ICAs and optic nerves and the location of the ICAs (asterisks: C3; stars: C4) by eliminating bony structures. (d) Endoscopic view after decompression of the tumor showing residual tumor bilaterally with descending diaphragma sellae (DS) centrally. (e, f) ICG endoscopic views visualizing the right ICA (asterisk: C3; star: C4) under the tumor and the normal pituitary gland (PG) at the posterior part of the diaphragma sellae. T: tumor.

Mentions: Case 3. A 59-year-old man visited our department after demonstrating gradually worsening visual field deficits. Coronal and sagittal Gd-enhanced MRI showed a macroadenoma involving bilateral ICAs with invasion into the sphenoidal sinus and destruction of the sellar floor (Figures 4(a) and 4(b)). Reconstructed 3D-CT and MRI fusion model images revealed the location of the optic canals and bilateral ICAs (Figure 4(c)). However, during the actual ETSS procedure, the extensive tumor made it difficult to identify the exact location of the ICAs that were buried in the tumor. The endoscopic view after decompression of the tumor within the safety zone demonstrated residual tumor bilaterally, with the descending diaphragma sellae situated centrally in the surgical field (Figure 4(d)). To confirm the exact location of the right ICA and the normal pituitary gland, we utilized ICG endoscopic visualization. The right ICA was visualized after ICG administration under the residual tumor (Figure 4(e)), and the fluorescent signal persisted until visualization of the normal pituitary gland, which was observed at the posterior part of the diaphragma sellae (Figure 4(f)). As a result, the tumor was removed as completely as possible without any complications, and the postoperative course was uneventful.


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 and ICG fluorescence views in Case 3. (a, b) Preoperative coronal and sagittal Gd-enhanced MRI in Case 3 showing a pituitary tumor extending into the sphenoidal sinus with involvement of both ICAs by the tumor. (c) Preoperative 3D-CT and MRI fusion model revealing the relationship between the tumor and the vital structures such as the ICAs and optic nerves and the location of the ICAs (asterisks: C3; stars: C4) by eliminating bony structures. (d) Endoscopic view after decompression of the tumor showing residual tumor bilaterally with descending diaphragma sellae (DS) centrally. (e, f) ICG endoscopic views visualizing the right ICA (asterisk: C3; star: C4) under the tumor and the normal pituitary gland (PG) at the posterior part of the diaphragma sellae. T: tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4539066&req=5

fig4: Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view and ICG fluorescence views in Case 3. (a, b) Preoperative coronal and sagittal Gd-enhanced MRI in Case 3 showing a pituitary tumor extending into the sphenoidal sinus with involvement of both ICAs by the tumor. (c) Preoperative 3D-CT and MRI fusion model revealing the relationship between the tumor and the vital structures such as the ICAs and optic nerves and the location of the ICAs (asterisks: C3; stars: C4) by eliminating bony structures. (d) Endoscopic view after decompression of the tumor showing residual tumor bilaterally with descending diaphragma sellae (DS) centrally. (e, f) ICG endoscopic views visualizing the right ICA (asterisk: C3; star: C4) under the tumor and the normal pituitary gland (PG) at the posterior part of the diaphragma sellae. T: tumor.
Mentions: Case 3. A 59-year-old man visited our department after demonstrating gradually worsening visual field deficits. Coronal and sagittal Gd-enhanced MRI showed a macroadenoma involving bilateral ICAs with invasion into the sphenoidal sinus and destruction of the sellar floor (Figures 4(a) and 4(b)). Reconstructed 3D-CT and MRI fusion model images revealed the location of the optic canals and bilateral ICAs (Figure 4(c)). However, during the actual ETSS procedure, the extensive tumor made it difficult to identify the exact location of the ICAs that were buried in the tumor. The endoscopic view after decompression of the tumor within the safety zone demonstrated residual tumor bilaterally, with the descending diaphragma sellae situated centrally in the surgical field (Figure 4(d)). To confirm the exact location of the right ICA and the normal pituitary gland, we utilized ICG endoscopic visualization. The right ICA was visualized after ICG administration under the residual tumor (Figure 4(e)), and the fluorescent signal persisted until visualization of the normal pituitary gland, which was observed at the posterior part of the diaphragma sellae (Figure 4(f)). As a result, the tumor was removed as completely as possible without any complications, and the postoperative course was uneventful.

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