title: Application of indocyanine green (ICG) fluorescence  for endoscopic biopsy of intraventricular tumors.
abstract: BACKGROUND
  Many reports have already indicated the benefit of pathological diagnosis of intra- and periventricular tumors with neuroendoscopic biopsy. However, it is also well known that studies can be occasionally inconclusive because of the small and/or inadequate samples for identification of abnormal tissues. The application of indocyanine green (ICG) fluorescence for endoscopical tumor biopsy under the intraventricular surroundings is a new area not previously reported. We attempted visual differentiation of intraventricular lesions from the surrounding structure using ICG fluorescence and considered the most appropriate region for biopsy.
  
  
  METHODS
  Three cases (13–14 year-old boys) with secondary hydrocephalus caused by intra- and periventricular tumors were operated for endoscopic transventricular biopsy combined with endoscopic third ventriculostomy. Final pathological diagnoses were suprasellar malignant lymphoma and germ cell tumors in two patients, both associated with intraventricular dissemination. Enhanced tumor visualization with 12.5 mg of ICG administration was obtained using the D-light P light equipment and ICG telescope 5.8 mm/19 cm.
  
  
  RESULTS
  It was possible to identify the tumor mass margins themselves and detect the differences of intratumoral ICG accumulation. The areas of tumor dissemination were identifiable by neuroendoscopy but unable to be visualized by ICG fluorescence.
  
  
  CONCLUSIONS
  We were able to obtain an ICG fluorescence imaging inside the cerebral ventricles by new D-light P system comprised of a camera head telescope. ICG fluorescence with neuroendoscopy can provide useful information for choosing the point of biopsy of intra- and periventricular tumors. However, we need to assess if the ICG accumulation site is the most appropriate for biopsy.
authors: Shunsuke
authors: S
authors: Tsuzuki
authors: Yasuo
authors: Y
authors: Aihara
authors: Seiichiro
authors: S
authors: Eguchi
authors: Kousaku
authors: K
authors: Amano
authors: Takakazu
authors: T
authors: Kawamata
authors: Yoshikazu
authors: Y
authors: Okada
mesh_terms: D000293:Adolescent; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery; D004396:Coloring Agents; D006801:Humans; D007208:Indocyanine Green; D007432:Intraoperative Period; D008297:Male; D044583:Neuroendoscopy / Q000295:instrumentation / Q000379:methods*; D061848:Optical Imaging / Q000295:instrumentation / Q000379:methods*; D020542:Third Ventricle / Q000601:surgery; D014696:Ventriculostomy / Q000295:instrumentation / Q000379:methods
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green
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