White Light and Near-Infrared Fluorescence Overlay and Image Fusion Enhances Surgical Workflow in Endoscopic Endonasal Surgery

 

Rapid advances in optical imaging have paved the way for novel applications in image-guided surgery. In neurosurgery, this is particularly evident in the innovative endoscopic endonasal approaches to the skull base which have caused a paradigm shift in tackling complex pathology during the last decade. The utilization and benefit of fluorescence-guided has been well reported in the neurosurgical literature, especially with indocyanine green (ICG), where its use has augmented vascular and oncologic surgery of the brain and skull base. The concept of a second-window ICG technique has been shown to be promising in both microscopic and endoscopic imaging modalities for brain tumors where it can be used in a similar fashion to 5-ALA to maximize tumor resection. The utilization of ICG endoscopy has also been used in the past several years but it has been limited to a monochromatic application with binary visualization of the tissue, limited to white light or fluorescence but not both simultaneously. In this study, we utilize a novel imaging technology, Karl Storz Image1 S Rubina, during endoscopic endonasal surgery which allows for contemporaneous use of white light and near-infrared fluorescence. The application of such should serve as both a proof of concept and also as an adjunct technique to enhance visualization and improve operative workflow. This can be of use to visualize vascular structures during tumor resection and reconstruction for closure with a vascularized and pedicled nasoseptal flap.

Publication History

Article published online:
15 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany