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Author Spotlight: Overcoming Anti-VEGF Resistance Through Advanced Vascular Morphology Assessment in Choroidal Neovascularization

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Multispectrum Indocyanine Green Videography for Visualizing Brain Vascular Pathology.

Kyousuke Kamada¹, Christoph Guger², Fumiya Takeuchi³

¹Department of Neurosurgery, Megumino Hospital, Eniwa, Japan; Computational Imaging Laboratory, Advanced Telecommunications Research Institute International, Kyoto, Japan.

World Neurosurgery

|August 24, 2019

Summary

This study introduces a new near-infrared (NIR) system for neurosurgery, enabling simultaneous visualization of indocyanine green (ICG) fluorescence and anatomical structures. This advancement improves blood flow assessment and surgical precision in brain vessel procedures.

Keywords:

Fluorescence Indocyanine green Regional blood flow Vascular surgical procedures

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Area of Science:

Neurosurgery
Medical Imaging
Optical Engineering

Background:

Current indocyanine green-videography (ICG-VG) in neurosurgery offers limited anatomical visualization.
Simultaneous assessment of blood flow and surgical anatomy is challenging with existing methods.

Purpose of the Study:

To develop a novel near-infrared (NIR) imaging system for simultaneous observation of ICG fluorescence and anatomical structures.
To enhance visualization during neurosurgical vascular procedures.

Main Methods:

Utilized a high-sensitivity NIR camera (980-nm component) with a high-pass filter on a surgical microscope.
Detected fluorescence signals between 770-1000 nm, illuminated by 980-nm wavelength light.
Projected combined anatomical and fluorescence images in real-time to smart glasses.

Main Results:

The new NIR system enabled simultaneous, real-time visualization of ICG fluorescence and anatomical structures without image fusion or delay.
Demonstrated enhanced detection of ICG fluorescence signals for longer durations, allowing detailed observation of vasculature.
Phantom experiments confirmed fluorescence signal changes based on emission light wavelength.

Conclusions:

The developed NIR system facilitates simultaneous observation of anatomy and fluorescence during neurosurgical operations.
This technology has potential applications in neuroendoscopy and robotic surgery.
Highlights the importance of integrating optics, natural science, and pathology for advanced optical systems.