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Intraoperative Fluorescence With Second Window Indocyanine Green Enhances Visualization During Vestibular Schwannoma
Kevin A Peng1, Gregory P Lekovic
1House Institute, Los Angeles, California.
Objective:
To investigate the utility of the so-called "second window" of indocyanine green (ICG) as a near-infrared fluorescent dye for intraoperative visualization.
Patients:
Three patients who underwent surgical resection of vestibular schwannoma (two retrosigmoid and one middle fossa approach).
Interventions:
Patients underwent intravenous infusion of ICG at a mean dose of 4.8 mg/kg at a mean of 15.3 hours before surgical incision. Once tumor dissection began, near-infrared fluorescence was used alongside conventional operative microscopy to visualize tumor tissue.
Main Outcome Measures:
Ability to distinguish tumor tissue from adjacent nerves.
Results:
Intraoperative fluorescence allowed for enhanced visualization of the tumor-nerve plane in all patients. However, the effect varied among patients, and the effect faded with increasing surgical time.
Conclusions:
ICG, a well-tolerated cyanine dye, demonstrates late fluorescence hours after administration secondary to diffusion into tumor as well as normal tissues (the so-called "second window" of fluorescence). Its fluorescence in the near-infrared spectrum is a promising adjunct for enhancing visualization of tumor planes during vestibular schwannoma surgery.
