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Intraoperative fluorescence and surgical outcomes in endoscopic resection of non-functioning pituitary macroadenomas:
Tomislav Felbabić1, Roman Bošnjak1
1Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia.
Objective:
Non-functioning pituitary macroadenomas are a common pathology of the sella region that require surgical treatment. Endoscopic endonasal transsphenoidal approach is the method of choice for the resection of these tumours. In our exploratory study, we wanted to investigate the feasibility of indocyanine green (ICG) dye in these procedures.
Methods:
This was a prospective, randomised pilot study involving patients with non-functioning pituitary macroadenomas. Patients were randomised into two groups. One group received ICG dye intraoperatively, while the control group did not. All patients were operated on using the endoscopic endonasal approach. Complications such as cerebrospinal fluid (CSF) leak, cranial nerve injury, haemorrhage, infection and incomplete tumour resection were noted.
Results:
A total of 34 patients were included (23 men, 11 women). Intraoperative CSF leak occurred in 29 % of the ICG group and 23 % of control group. Postoperative CSF leak was seen in 23 % and 18 %, respectively. Visual deterioration occurred in 6 % and 0 %. No haematomas were observed in the ICG group, compared to 6 % in controls. Residual tumour was detected in 12 % of the ICG group compared to 18 % of the control group on follow-up MRI.
Conclusions:
Based on our underpowered study, we cannot conclude that the use of ICG dye in these procedures improves patient outcomes. Larger, adequately powered studies are needed to further evaluate the potential feasibility of ICG in such surgeries.