Page 74 - Fluorescence-guided cancer surgery

72
Chapter 5
complete tumor resection. Like MRI gadolinium enhancement, NIR uorescence imaging showed illumination of the normal gland, and delay in illumination of the adenoma. However, unlike gadolinium use for MRI of pituitary tumors, NIR uorescence imaging has never become widely accepted in clinical practice.
The aim of the current study was to assess the feasibility and potential value of NIR uorescence imaging in endoscopic pituitary surgery. The detection of the normal gland, with the aid of low-dose ICG was studied and the detected uorescent signal was scored both qualitatively and quantitatively. Moreover, the possibility to resect adenoma tissue under only NIR uorescence guidance was evaluated.
METHODS
Patients
Patients included in the study were those diagnosed with a pituitary gland adenoma and having rst been scheduled for their initial endoscopic transnasal transsphenoidal surgical resection between January 2013 and March 2014. Only one endoscope and light cable suitable for NIR uorescence imaging were available, allowing a maximum of one patient per day to be included. All patients gave informed consent. Exclusion criteria were previous transsphenoidal surgery, pregnancy, lactation, renal impairment (eGFR<55) or an allergy to iodine or ICG.
Clinical trial
This clinical trial was performed at the Leiden University Medical Center, a tertiary referral center. The study was approved by the local Medical Ethics Committee and was performed in accordance with the ethical standards of the Helsinki Declaration of 1975.
Patients underwent a standard-of-care endoscopic transnasal transsphenoidal selective adenomectomy, conducted by a team of two neurosurgeons with a vast experience in pituitary surgery. During the procedure, 5 mg ICG was administered intravenously at di erent time points. The rst ICG gift was after exposure of the sellar dura, but prior to opening. The NIR compatible endoscopic device (Image Hub I by Karl Storz GmbH & Co. KG Germany) was used to identify the uorescent signal. After opening the dura,