Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumours |
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| Institution: | 1. Department of Plastic and Reconstructive Surgery (Head: M. Kon), University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands;2. Department of Neurosurgery (Head: L.P.E. Regli), University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands;3. Department of Oral-Maxillofacial Surgery (Head: R. Koole), University of Utrecht Medical Center, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, The Netherlands;1. Department of Maxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, China;2. Department of Craniomaxillofacial Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Science, Peking Union Medical College, No 33, Ba-Da-Chu Road, Shi Jing Shan District, Beijing 100144, China;1. Department of Neurosurgery, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy;2. Department of Neurosurgery, George Washington University, Washington DC, USA;1. Institute of Functional and Clinical Anatomy, University Medical Center Mainz (Head: Univ.-Prof. Dr. E. Schulte), Becherweg 13, 55099 Mainz, Germany;2. Department of Oral and Maxillofacial Surgery, University Medical Center Mainz (Head: Univ.-Prof. Dr. Dr. W. Wagner), Augustusplatz 2, 55131 Mainz, Germany;3. Swiss Light Source, Paul Scherrer Institute (Beamline Head: Prof. Dr. M. Stampanoni), 5232 Villigen PSI, Switzerland;1. Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;2. Fraunhofer Institute for Non-Destructive Testing, Laboratory of Optical Diagnostics, Dresden, Germany;3. Martiniclinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;4. Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany |
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| Abstract: | In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to resect tumours safely in narrow parapharyngeal space, we propose indocyanine green (ICG) florescence image for navigation surgery.ObjectiveTo evaluate the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumours.Methods0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was performed with HEMS (HyperEye Medical System) at 10–30 min after injection. At first, the position of the tumour was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. We also confirmed submucosal tumours hidden under fascia using HEMS imaging again and resected them.ResultsAll tumours displayed bright fluorescence emissions which clearly contrasted with the normal structures. Even with the submucosal tumour covered with and obscured by fasciae, we could observe the tumour clearly under HEMS imaging. Tumours behind the carotid artery and lower cranial nerves also were displayed bright fluorescence emissions and were clearly detected. As a result, we could completely remove the tumour safely and noninvasively to preserve pharyngeal functions.ConclusionICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumours with preserving functions. |
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| Keywords: | Indocyanine green (ICG) Navigation surgery Parapharyngeal space tumours Head and neck cancer Robotic surgery Endoscopic surgery Minimally invasive surgery |
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