title: Intraoperative indocyanine green videoangiography for identification of pituitary adenomas using a microscopic transsphenoidal approach.
abstract: OBJECTIVE
  Initial successful surgical treatment of pituitary adenomas is crucial to reach long-term remission. Indocyanine green (ICG) videoangiography (VA) is well established in vascular neurosurgery nowadays and several reports described ICG application in brain tumor surgery. We designed this study to evaluate the feasibility of intravenous application of ICG and visualisation of a pituitary lesion via the fluorescence mode of the operation microscope.
  
  
  METHODS
  22 patients with pituitary adenomas were treated with transsphenoidal microsurgery and were included in this study. Intraoperatively 25 mg ICG was administered intravenously and visualized via the fluorescence mode of the operation microscope (Pentero/Zeiss).
  
  
  RESULTS
  22 patients qualified for transsphenoidal surgery presenting with different clinical symptoms (13 patients with acromegaly, 6 with M. Cushing and 3 with other symptoms like vision disorder or dizziness) and identification of a pituitary lesion (21 of 22 patients) in preoperative MR-imaging (mean diameter: 9 mm; SD 3.6; 6 macroadenomas, 15 microadenomas, 1 MR-negative). In all 22 patients ICG VA was performed during surgery. No technical failures or adverse events after drug administration occurred. Visualization was optimal approximately 2.4 min after intravenous application. In all patients the adenoma could be detected via two different types of visualization: direct visualization by fluorophore emission versus indirect detection of the adenoma by a lower ICG fluorescence compared to the surrounding tissue.
  
  
  CONCLUSIONS
  Our data show that intraoperative ICG VA can be a useful and easily applicable additional diagnostic tool for visualization of pituitary lesions using the microscopic approach.
authors.affiliation: Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Sandow
authors.forename: W
authors.initials: W
authors.lastname: Klene
authors.forename: U
authors.initials: U
authors.lastname: Elbelt
authors.forename: C J
authors.initials: CJ
authors.lastname: Strasburger
authors.forename: P
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D000236:Adenoma / Q000098:blood supply / Q000150:complications / Q000473:pathology / Q000601:surgery*; D061605:Administration, Intravenous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography / Q000379:methods*; D004396:Coloring Agents / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007016:Hypophysectomy / Q000379:methods*; D007208:Indocyanine Green / Q000008:administration & dosage*; D007430:Intraoperative Care; D008279:Magnetic Resonance Imaging; D008297:Male; D008856:Microscopy, Fluorescence; D018715:Microscopy, Video; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000098:blood supply / Q000150:complications / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green