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Fluorescence-Guided Neurosurgery (Neuro-oncology and Cerebrovascular Applications) || 1 Current Fluorescence-Guided Neurosurgery and Moving Forward
摘要： This introductory chapter provides a current overview of fluorescence-guided neurosurgery and includes future directions. The concepts of fluorescence and fluorescence-guided surgery (FGS) are introduced. Currently used fluorescent contrast agents in patients are summarized, including 5-aminolevulinic acid (5-ALA), fluorescein, and indocyanine green. Excitation light sources are discussed for each fluorescent contrast agent. Targeted fluorophores under clinical development for FGS are also introduced. Future directions in fluorescence-guided neurosurgery including handheld devices to better detect tumor fluorescence, dual fluorophore imaging, metabolic imaging in combination with FGS, and detection of the tumor margin will be discussed.
关键词： near-infrared imaging,fluorophore,indocyanine green,fluorescence-guided neurosurgery,fluorescence,operative microscope,fluorescence-guided surgery,fluorescein sodium,5-ALA
更新于2025-09-19 17:15:36
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Usefulness of colonic tattooing using indocyanine green in patients with colorectal tumors
摘要： AIM: To prove that tattooing using indocyanine green (ICG) is feasible in laparoscopic surgery for a colon tumor. METHODS: From January 2012 to December 2016, all patients who underwent laparoscopic colonic surgery were retrospectively screened, and 1010 patients with colorectal neoplasms were included. Their lesions were tattooed with ICG the day before the operation. The tattooed group (TG) included 114 patients, and the non-tattooed group (NTG) was selected by propensity score matching of subjects based on age, sex, tumor staging, and operation method (n = 228). In total, 342 patients were enrolled. Between the groups, the changes in [Delta (Δ), preoperative-postoperative] the hemoglobin and albumin levels, operation time, hospital stay, oral ingestion period, transfusion, and perioperative complications were compared. RESULTS: Preoperative TG had a shorter operation time (174.76 ± 51.6 min vs 192.63 ± 59.9 min, P < 0.01), hospital stay (9.55 ± 3.36 d vs 11.42 ± 8.23 d, P < 0.01), and postoperative oral ingestion period (1.58 ± 0.96 d vs 2.81 ± 1.90 d, P < 0.01). The Δ hemoglobin (0.78 ± 0.76 g/dL vs 2.2 ± 1.18 g/dL, P < 0.01) and Δ albumin (0.41 ± 0.44 g/dL vs 1.08 ± 0.39 g/dL, P < 0.01) levels were lower in the TG. On comparison of patients in the “N0” and “N1 or N2” groups, the N0 colon cancer group had a better operation time, length of hospital stay, oral ingestion period, Δ hemoglobin, and Δ albumin results than those of the N1 or N2 group. The operation methods affected the results, and laparoscopic anterior resection (LAR) showed similar results. However, for left and right hemicolectomy, both groups showed no difference in operation time or hospital stay. CONCLUSION: Preoperative tattooing with ICG is useful for laparoscopic colectomy, especially in the N0 colon cancer group and LAR.
关键词： Colorectal neoplasm,Laparoscopic surgery,Perioperative,Indocyanine green,Endoscopic tattoo
更新于2025-09-19 17:15:36
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Fluorescence contrast-enhanced proliferative lesion imaging by enema administration of indocyanine green in a rat model of colon carcinogenesis
摘要： The fluorescent contrast agent indocyanine green (ICG) is approved by the Food and Drug Administration for clinical applications. We previously reported that cultured human colon tumor cells preferentially take up ICG by endocytic activity in association with disruption of their tight junctions. The present study explored ICG availability in fluorescence imaging of the colon to identify proliferative lesions during colonoscopy. The cellular uptake of ICG in cultured rat colon tumor cells was examined using live-cell imaging. Colon lesions in rats administered an ICG-containing enema were further assessed in rats with azoxymethane-induced colon carcinogenesis, using in vivo endoscopy, ex vivo microscopy, and immunofluorescence microscopy. The uptake of ICG by the cultured cells was temperature-dependent. The intracellular retention of the dye in the membrane trafficking system suggested endocytosis as the uptake mechanism. ICG administered via enema accumulated in colon proliferative lesions ranging from tiny aberrant crypt foci to adenomas and localized in proliferating cells. Fluorescence endoscopy detected these ICG-positive colonic proliferative lesions in vivo. The immunoreactivity of the tight-junction molecule occludin was altered in the proliferative lesions, suggesting the disruption of the integrity of tight junctions. These results suggest that fluorescence contrast-enhanced imaging following the administration of an ICG-containing enema can enhance the detection of mucosal proliferative lesions of the colon during colonoscopy. The tissue preference of ICG in the rat model evaluated in this study can be attributed to the disruption of tight junctions, which in turn promotes endocytosis by proliferative cells and the cellular uptake of ICG.
关键词： colon tumor,endoscopy,fluorescence imaging,indocyanine green,tight junction
更新于2025-09-19 17:15:36
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Microvascular fluorescence in spinal cord repair
摘要： The release of the placode and reconstruction of the myelomeningocele preserving the maximum of neural tissue is a challenge for the neurosurgeons. Vascular fluorescence with indocyanine green and / or fluorescein allows to observe the microvascularization of the spinal cord and adequately identify viable tissue.
关键词： myelomeningocele,microneurosurgery,fluorescein,indocyanine green,Spinal cord
更新于2025-09-19 17:15:36
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The use of ICG enhanced fluorescence for the evaluation of parathyroid gland preservation
摘要： Indocyanine green (ICG) enhanced fluorescence imaging is recent innovation as the “real-time intraoperative imaging” technique. Many clinical studies have been reported in the literature which use different devices and techniques that employ various doses and usages of ICG as a non-specific contrast agent. Several groups have performed studies in endocrine surgery, especially with regards to parathyroid-related outcomes after thyroid and parathyroid surgery. However, there is no consensus on the technical details that should be applied. With this study, we aimed to review the current literature on potential use of intraoperative ICG angiography for evaluating parathyroid gland (PTG) preservation.
关键词： parathyroid,Indocyanine green,preservation,ICG
更新于2025-09-19 17:15:36
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Comparison of indocyanine green fluorescence and parathyroid autofluorescence imaging in the identification of parathyroid glands during thyroidectomy
摘要： Background: Indocyanine green fluorescence (ICGF) and parathyroid autofluorescence (AF) are two new techniques that aid in the identification of parathyroid glands (PG) intraoperatively during thyroidectomy. There is no study comparing the efficacy of these techniques. Methods: This was an IRB-approved clinical study comparing the utility of ICGF and AF for identification of PGs during thyroidectomy. Data were collected prospectively. Both techniques were compared to naked eye (NE) for PG detection. Standard statistical methods were used for data analysis. Results: Twenty-two patients in each group underwent a total of 39 total thyroidectomies and 5 thyroid lobectomies. AF and ICGF had similar detection rates for PGs [98% (61 of 62) and 95% (60 of 63) of PGs, respectively; P=0.31]. The location of PGs was suggested before detection with NE more frequently by AF than ICGF [52% (32 of 62) vs. 6% (4 of 63) of PGs; P<0.001]. In 82% (18 of 22) of patients at least one PG was detected by AF before NE, as opposed to 14% (3 of 22) by ICGF (P<0.001). The median (range) number of PGs detected before NE per patient was greater with AF than ICGF [2 (0–3) vs. 0 (0–2)]. Upper PGs were more likely to be detected by AF before recognition with NE than the lower ones (P=0.03). There was no predictive factor for ICGF detection. Postoperative hypocalcemia rates were similar [9% (2 of 22) and 5% (1 of 22) for AF and ICGF, respectively; P>0.99]. Conclusions: To the best of our knowledge, this is the first comparative study between parathyroid AF and ICGF in detection of PGs during thyroidectomy. Our data suggest both techniques have similarly high detection rates and that the main difference lies in the timing of detection. AF more frequently detects PGs before recognition with NE compared to ICGF.
关键词： Parathyroid autofluorescence (AF),indocyanine green fluorescence (ICGF),thyroid surgery
更新于2025-09-19 17:15:36
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Applications of indocyanine green based near-infrared fluorescence imaging in thoracic surgery
摘要： Near-infrared (NIR) fluorescence guided surgery is an emerging technique. This technique uses the combination of dyes and NIR imaging devices to expand the visible spectrum. Thus it can provide more anatomic and functional information, and may facilitate a more complete resection of cancer, or better protection of important normal structures. Recently, significant progress has been made in the field of NIR fluorescence guided thoracic surgery. This may lead to better prognosis and health-economic outcomes. In this article, the current studies of indocyanine green (ICG) based NIR fluorescence guided thoracic surgeries are reviewed. The applications are classified into four categories, which are applications based on blood supply, lymphatic drainage, the enhanced permeability and retention (EPR) effect, and the other mechanisms.
关键词： lymphatic drainage,enhanced permeability and retention effect (EPR effect),indocyanine green (ICG),Near-infrared fluorescence,blood supply
更新于2025-09-19 17:15:36
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Clinical use of near-infrared fluorescence imaging with indocyanine green in thoracic surgery: a literature review
摘要： Invisible near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has advantage in detecting for certain anatomy. The method is currently used in some types of surgery, such as sentinel lymph node (SLN) mapping, intraoperative solid tumor identification, and organ perfusion assessment. However, the literature of clinical application in thoracic surgery is lacking. This paper presents the advantages, current applications and potential developments of NIR fluorescence imaging with ICG in thoracic surgery.
关键词： fluorescence,thoracic surgery,Indocyanine green (ICG)
更新于2025-09-19 17:15:36
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Identification of extrahepatic metastasis of hepatocellular carcinoma using indocyanine green fluorescence imaging
摘要： Background/purpose: Intraoperative fluorescence imaging with indocyanine green (ICG) plays a significant role in the identification of hepatocellular carcinoma (HCC) during Hepatectomy. Despite that, few researchers have reported using ICG fluorescence imaging to detect extrahepatic metastases. Herein, we report the successful application of ICG fluorescence imaging in the detection of extrahepatic metastatic lesions from primary liver cancer. Methods : In two HCC patients, a near-infrared fluorescence imaging system was used to intraoperatively examine the abdominal cavity implantation metastasis after multiple hepatectomy and the primary tumor after the pre-operation with ICG . Results: In the first case, the abdominal cavity implantation metastasis exhibited intense fluorescence and clear boundaries of tumors during abdominal tumor resection, and there was no fluorescence in the resection margin. In the second case, a new lesion that was not detected by preoperative imaging examination was found in the omentum by ICG fluorescence imaging. Intraoperative rapid freezing pathology showed that it was an adenocarcinoma. Accordingly, we revised the tumor staging. Conclusion: ICG fluorescence imaging can not only detect intrahepatic metastases, but also extrahepatic metastases. Furthermore, it can help surgeons correct tumor staging during surgery.
关键词： indocyanine green,implantation metastasis,fluorescence imaging
更新于2025-09-19 17:15:36
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A new method of near-infrared fluorescence image-guided hepatectomy for patients with hepatolithiasis: a??randomized controlled trial
摘要： Background Hepatectomy is a definitive treatment for hepatolithiasis because it simultaneously removes intrahepatic duct (IHD) stones and biliary tract strictures together with the involved liver region en bloc. Unlike cystic or solid liver tumors, hepatolithiasis is usually associated with alterations of anatomical structures and perihepatic adhesions because of chronic recurrent inflammation. This complicates identification of the target hepatic region and location of biliary strictures. Methods To determine the efficacy of near-infrared fluorescence (NIRF) imaging using indocyanine green (ICG), we performed a comparative trial and developed a white-light and near-infrared dual-channel image-guided device (DPM-I) for both open and endoscopic surgery. Forty-four eligible patients were randomly assigned to Group A (NIRF imaging) or Group B (traditional hepatectomy). We injected ICG via peripheral veins for patients in Group A. Results The NIRF imaging method was associated with less blood loss (OR 1.004, 95% CI 0.999–1.010; P = 0.016), briefer hospitalization (OR 1.336, 95% CI 1.016–1.756; P = 0.001), lower rates of margins with dilated bile ducts (OR 1.278, 95% CI 1.030–1.585; P = 0.023), lower postoperative white blood cell counts (OR 1.262, 95% CI 0.931–1.712; P = 0.038), lower procalcitonin levels (OR 1.316, 95% CI 1.020–1.513; P = 0.002), and lower alanine aminotransferase levels (OR 1.013, 95% CI 1.003–1.023; P = 0.002) compared with traditional hepatectomy. Conclusions These data demonstrate the efficacy of NIRF imaging with ICG using DPM-I for treating hepatolithiasis.
关键词： Hepatolithiasis,Near-infrared fluorescence,Indocyanine green,Fluorescence image-guided hepatectomy,Intraoperative imaging
更新于2025-09-19 17:13:59