Rapid intraoperative localization of parathyroid glands utilizing methylene blue infusion.
OBJECTIVE
To review a single surgeon's experience utilizing an intraoperative methylene blue infusion (IMBI) to identify parathyroid glands during neck exploration for primary hyperparathyroidism.


METHODS
Retrospective review of 35 patients who underwent bilateral neck exploration utilizing an IMBI at a dose of 7.5 mg/kg following the induction of general anesthesia.


RESULTS
All patients reverted to normocalcemia with a mean follow-up of 17 months. IMBI facilitated the identification of abnormal parathyroid tissue in 34/35 patients (97%). A dark blue-purple staining was observed in 33/37 stained adenomas (89%). Four adenomas and four hyperplastic glands stained a lighter shade of blue-green. Among 89 normal glands, 41(46%) stained a pale green-grey color.


CONCLUSIONS
IMBI is a safe, readily available, cost-effective, and underutilized technique that facilitates rapid identification of parathyroid adenomas, helps distinguish normal glands from hyperplastic glands, and helps to locate ectopic glands. An overall reduction in operative time, especially for bilateral neck exploration, can be anticipated.
Kuriloff
Daniel B
DB
Department of Otolaryngology-Head and Neck Surgery, St. Luke's-Roosevelt Hospital Center and Columbia Univeristy College of Physicians and Surgeons, New York, NY 10019-1104, USA. dkuriloff@aol.com
Sanborn
Kevin V
KV
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage; D008875:Middle Aged; D010280:Parathyroid Glands / Q000033:anatomy & histology / Q000473:pathology*; D016105:Parathyroidectomy / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D004396:Coloring Agents; D008751:Methylene Blue