ArticleOperative neurosurgery (Hagerstown, Md.)2019
Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery.
Article in Operative neurosurgery (Hagerstown, Md.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 37 citations in OpenAlex.
- Indocyanine green fluorescence in endoscopic transsphenoidal resection of pituitary neuroendocrine tumors: a systematic review.Acta neurochirurgica · 2025Pooled it
- Guidelines in the management of CNS tumors.Journal of neuro-oncology · 2021Guideline
- NIR autofluorescence allows for pituitary gland detection during surgery: evidence from microscopic studies and in vivo measurements.Biomedical optics express · 2026Article
- Application and Outcomes of Indocyanine Green in Endoscopic Transsphenoidal Surgery for Functional Pituitary Tumors: A Literature Review.Brain sciences · 2026Review
- NIR Indocyanine-White Light Overlay Visualization for Neuro-Oto-Vascular Preservation During Anterior Transpetrosal Approaches: A Technical Note.Journal of clinical medicine · 2025Article
- Intraoperative nerve-specific fluorescence visualization in head and neck surgery: a Phase 1 trial.Nature communications · 2025Article
- Cerebral Aneurysms and Arteriovenous Malformation: Preliminary Experience with the Use of Near-Infrared Fluorescence Imaging Applied to Endoscopy.Journal of personalized medicine · 2024Article
- Hypopituitarism, Diabetes Insipidus, and Syndrome of Inappropriate Antidiuretic Hormone Secretion after Pituitary Macroadenoma Surgery with Indocyanine Green Dye.Diagnostics (Basel, Switzerland) · 2024Article
- Fluorescence guidance in skull base surgery: Applications and limitations - A systematic review.Brain & spine · 2024Review
- Fluorophores in Endoscopic Neurosurgery.Advances and technical standards in neurosurgery · 2024Review
- The Current State of Visualization Techniques in Endoscopic Skull Base Surgery.Brain sciences · 2022Review
- Fluorophores Use in Pituitary Surgery: A Pharmacokinetics and Pharmacodynamics Appraisal.Brain sciences · 2021Review
- Second-Window Indocyanine Green for Visualization of Hemangioblastoma: A Case Report With Two-Dimensional Operative Video.Operative neurosurgery (Hagerstown, Md.) · 2021Article
- Fluorescence guided surgery for pituitary adenomas.Journal of neuro-oncology · 2021Review
- Indocyanine Green-Guided Pediatric Tumor Resection: Approach, Utility, and Challenges.Frontiers in pediatrics · 2021Article
- Diagnosis of Pituitary Adenoma Biopsies by Ultrahigh Resolution Optical Coherence Tomography Using Neuronal Networks.Frontiers in endocrinology · 2021Article
- Blood-Brain Barrier, Blood-Brain Tumor Barrier, and Fluorescence-Guided Neurosurgical Oncology: Delivering Optical Labels to Brain Tumors.Frontiers in oncology · 2020Review
- Review of clinical trials in intraoperative molecular imaging during cancer surgery.Journal of biomedical optics · 2019Review
- Indocyanine-Green for Fluorescence-Guided Surgery of Brain Tumors: Evidence, Techniques, and Practical Experience.Frontiers in surgery · 2019Article
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Authors and funding
11 authors at 1 institution in 1 country.
Funding
Abstract
backgroundNear-infrared (NIR) tumor contrast is achieved through the "second-window ICG" technique, which relies on passive accumulation of high doses of indocyanine green (ICG) in neoplasms via the enhanced permeability and retention effect.
objectiveTo report early results and potential challenges associated with the application of second-window ICG technique in endonasal endoscopic, ventral skull-base surgery, and to determine potential predictors of NIR signal-to-background ratio (SBR) using endoscopic techniques.
methodsPituitary adenoma (n = 8), craniopharyngioma (n = 3), and chordoma (n = 4) patients received systemic infusions of ICG (5 mg/kg) approximately 24 h before surgery. Dual-channel endoscopy with visible light and NIR overlay were photodocumented and analyzed post hoc.
resultsAll tumors (adenoma, craniopharyngioma, chordoma) demonstrated NIR positivity and fluoresced with an average SBR of 3.9 ± 0.8, 4.1 ± 1.7, and 2.1 ± 0.6, respectively. Contrast-enhanced T1 signal intensity proved to be the single best predictor of observed SBR (P = .0003). For pituitary adenomas, the sensitivity, specificity, positive predictive value, and negative predictive value of NIR-guided identification of tumor was 100%, 20%, 71%, and 100%, respectively.
conclusionIn this preliminary study of a small set of patients, we demonstrate that second-window ICG can provide NIR optical tumor contrast in 3 types of ventral skull-base tumors. Chordomas demonstrated the weakest NIR signal, suggesting limited utility in those patients. Both nonfunctional and functional pituitary adenomas appear to accumulate ICG, but utility for margin detection for the adenomas is limited by low specificity. Craniopharyngiomas with third ventricular extension appear to be a particularly promising target given the clean brain parenchyma background and strong SBR.
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