Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery

Jeon, Jun; Cho, Steve S.; Nag, Shayoni; Buch, Love; Pierce, J. Thomas; Su, YouRong Sophie; Adappa, Nithin D.; Palmer, James N.; Newman, Jason G.; Singhal, Sunil; Lee, John Y.K.

doi:10.1093/ons/opy213

Cited by 27 publications

(14 citation statements)

References 35 publications

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“…This study and subsequent reports in skull base tumors found that Gd enhancement on T1-weighted MRI was the strongest predictor of positive fluorescence, whereas nonenhancing tumors did not fluoresce, providing insight into the mechanism of ICG localization. 7,16 In 2012, Ergin et al had proposed using intravenous ICG injections to optically monitor blood-brain barrier (BBB) disruption, taking advantage of the same EPR effect proposed to underpin ICG accumulation in the tumor microenvironment. 17 In the initial SWIG study from 2016, findings in patients with contrast-enhancing gliomas (12/15) were used to calculate diagnostic test characteristics.…”

Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

“…Other studies have demonstrated ICG's ability to visualize chordoma, craniopharyngioma, pineocytoma, and intraventricular tumors. 16,22,23 Because the ultimate goal of FGS is to maximize extent of resection, studies by Cho et al in 2020 24 and Teng et al 76 comparing NIR fluorescence to the gold standard postoperative MRI showed that the absence of re- sidual NIR signal postresection closely correlated to GTR of HGGs (p < 0.0001) and intracranial metastases (p = 0.007) on MRI. One limitation of these findings, however, is intrinsic to the SWIG technique itself.…”

Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

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Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Teng

Huang

Arguelles

et al. 2021

Neurosurgical Focus

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Indocyanine green (ICG) is a water-soluble dye that was approved by the FDA for biomedical purposes in 1956. Initially used to measure cardiocirculatory and hepatic functions, ICG’s fluorescent properties in the near-infrared (NIR) spectrum soon led to its application in ophthalmic angiography. In the early 2000s, ICG was formally introduced in neurosurgery as an angiographic tool. In 2016, the authors’ group pioneered a novel technique with ICG named second-window ICG (SWIG), which involves infusion of a high dose of ICG (5.0 mg/kg) in patients 24 hours prior to surgery. To date, applications of SWIG have been reported in patients with high-grade gliomas, meningiomas, brain metastases, pituitary adenomas, craniopharyngiomas, chordomas, and pinealomas.The applications of ICG have clearly expanded rapidly across different specialties since its initial development. As an NIR fluorophore, ICG has advantages over other FDA-approved fluorophores, all of which are currently in the visible-light spectrum, because of NIR fluorescence’s increased tissue penetration and decreased autofluorescence. Recently, interest in the latest applications of ICG in brain tumor surgery has grown beyond its role as an NIR fluorophore, extending into shortwave infrared imaging and integration into nanotechnology. This review aims to summarize reported clinical studies on ICG fluorescence–guided surgery of intracranial tumors, as well as to provide an overview of the literature on emerging technologies related to the utility of ICG in neuro-oncological surgeries, including the following aspects: 1) ICG fluorescence in the NIR-II window; 2) ICG for photoacoustic imaging; and 3) ICG nanoparticles for combined diagnostic imaging and therapy (theranostic) applications.

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Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

Section: Clinical Trials Of Icg For Fluorescence-guided Intracranial mentioning

confidence: 99%

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Teng

Huang

Arguelles

et al. 2021

Neurosurgical Focus

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“…Finally, SWIG is applicable to skull base tumors, such as pituitary adenomas, chordomas, and craniopharyngiomas, which were accessed via the transnasal/transsphenoidal approach. A 2018 study of 8 pituitary adenomas, 3 craniopharyngiomas, and 4 chordomas demonstrated that all the tumors demonstrated NIR fluorescence ( Figure 6 ) ( 53 ). Again, contrast-enhancement on preoperative MRI was the best predictor of NIR fluorescence contrast to normal background ( p -value = 0.0003).…”

Section: Evidence and Potential Benefits Of Swigmentioning

confidence: 99%

“…Patients with chordomas (top row), craniopharyngiomas (middle row), and pituitary adenomas (bottom row) all demonstrate NIR fluorescence with SWIG. Visualization was performed with a NIR-sensitive endoscope system ( 53 ).…”

Section: Evidence and Potential Benefits Of Swigmentioning

confidence: 99%

Indocyanine-Green for Fluorescence-Guided Surgery of Brain Tumors: Evidence, Techniques, and Practical Experience

2019

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The primary treatment for brain tumors often involves surgical resection for diagnosis, relief of mass effect, and prolonged survival. In neurosurgery, it is of utmost importance to achieve maximal safe resection while minimizing iatrogenic neurologic deficit. Thus, neurosurgeons often rely on extra tools in the operating room, such as neuronavigation, intraoperative magnetic resonance imaging, and/or intraoperative rapid pathology. However, these tools can be expensive, not readily available, time-consuming, and/or inaccurate. Recently, fluorescence-guided surgery has emerged as a cost-effective method to accurately visualize neoplastic areas in real-time to guide resection. Currently, 5-aminolevulinic-acid (5-ALA) remains the only fluorophore that has been approved specifically for fluorescence-guided tumor resection. Its use has demonstrated improved resection rates and prolonged progression-free survival. However, protoporphyrin-IX, the metabolic product of 5-ALA that accumulates in neoplastic cells, fluoresces in the visible-light range, which suffers from limited tissue penetration and significant auto-fluorescence. Near-infrared fluorescence, on the other hand, overcomes these problems with ease. Since 2012, researchers at our institution have developed a novel technique using indocyanine-green, which is a well-known near-infrared fluorophore used traditionally for angiography. This Second-Window-ICG (SWIG) technique takes advantage of the increased endothelial permeability in peritumoral tissue, which allows indocyanine-green to accumulate in these areas for intraoperative visualization of the tumor. SWIG has demonstrated utility in gliomas, meningiomas, metastases, pituitary adenomas, chordomas, and craniopharyngiomas. The main benefits of SWIG stem from its highly sensitive detection of neoplastic tissue in a wide variety of intracranial pathologies in real-time, which can help neurosurgeons both during surgical resections and in stereotactic biopsies. In this review of this novel technique, we summarize the development and mechanism of action of SWIG, provide evidence for its benefits, and discuss its limitations. Finally, for those interested in near-infrared fluorescence-guided surgery, we provide suggestions for maximizing the benefits while minimizing the limitations of SWIG based on our own experience thus far.

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“…26 This approach has allowed neurosurgeons to visualize fluorescence confined to the neoplastic tissue of HGG, meningiomas, metastases, and pituitary adenomas with surprisingly high signal-to-background ratios. [27][28][29][30][31][32] Indeed, the visualization of abnormal tissue is very similar to principles of gadolinium contrast-enhancement in MRI, which relies on passive diffusion of contrast agent into abnormal tumor tissue with permeable vascular endothelium. Since gadolinium enhancement is the very basis of the definition of gross total resection or partial resection of glioma in surgical outcome studies for glioblastoma, SWIG TumorGlow™ has the potential to help neurosurgeons increase the extent of resection in HGG resections.…”

Section: Tumorglow™ For Adult Brain Tumorsmentioning

confidence: 98%

Review of clinical trials in intraoperative molecular imaging during cancer surgery

et al. 2019

Self Cite

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Most solid cancers are treated by surgical resections to reduce the burden of disease. Surgeons often face the challenge of detecting small areas of residual neoplasm after resection or finding small primary tumors for the initial resection. Intraoperative molecular imaging (IMI) is an emerging technology with the potential to dramatically improve cancer surgery operations by allowing surgeons to better visualize areas of neoplasm using fluorescence imaging. Over the last two years, two molecular optical contrast agents received U.S. Food and Drug Administration approval, and several more drugs are now on the horizon. Thus a conference was organized at the University of Pennsylvania to bring together oncologic surgeons from different specialties to discuss the current clinical status of IMI trials with a specific focus on phase 2 and phase 3 studies. In addition, phase 1 and experimental trials were also discussed briefly, to highlight other novel techniques. Our review summarizes the discussions from the conference and delves into the types of cancers discussed, different contrast agents in human trials, and the clinical value being studied.

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Near-Infrared Optical Contrast of Skull Base Tumors During Endoscopic Endonasal Surgery

Cited by 27 publications

References 35 publications

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Applications of indocyanine green in brain tumor surgery: review of clinical evidence and emerging technologies

Indocyanine-Green for Fluorescence-Guided Surgery of Brain Tumors: Evidence, Techniques, and Practical Experience

Review of clinical trials in intraoperative molecular imaging during cancer surgery

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