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Assessment and Comparison of Three Dimensional Exoscopes for Near-Infrared Fluorescence-Guided Surgery Using Second-Window Indocyanine-Green

Journal of Korean Neurosurgical Society 2022년 65권 4호 p.572 ~ 581
Cho Steve S., Teng Clare W., De Ravin Emma, Singh Yash B., Lee John Y. K.,
소속 상세정보
 ( Cho Steve S. ) - University of Pennsylvania Hospital Department of Neurosurgery
 ( Teng Clare W. ) - University of Pennsylvania Perelman School of Medicine
 ( De Ravin Emma ) - University of Pennsylvania Perelman School of Medicine
 ( Singh Yash B. ) - University of Pennsylvania Hospital Department of Neurosurgery
 ( Lee John Y. K. ) - University of Pennsylvania Hospital Department of Neurosurgery

Abstract


Objective: Compared to microscopes, exoscopes have advantages in field-depth, ergonomics, and educational value. Exoscopes are especially well-poised for adaptation into fluorescence-guided surgery (FGS) due to their excitation source, light path, and image processing capabilities. We evaluated the feasibility of near-infrared FGS using a 3-dimensional (3D), 4 K exoscope with near-infrared fluorescence imaging capability. We then compared it to the most sensitive, commercially-available near-infrared exoscope system (3D and 960 p). In-vitro and intraoperative comparisons were performed.

Methods: Serial dilutions of indocyanine-green (1-2000 μg/mL) were imaged with the 3D, 4 K Olympus Orbeye (system 1) and the 3D, 960 p VisionSense Iridium (system 2). Near-infrared sensitivity was calculated using signal-to-background ratios (SBRs). In addition, three patients with brain tumors were administered indocyanine-green and imaged with system 1, with two also imaged with system 2 for comparison.

Results: Systems 1 and 2 detected near-infrared fluorescence from indocyanine green concentrations of >250 μg/L and >31.3 μg/L, respectively. Intraoperatively, system 1 visualized strong near-infrared fluorescence from two, strongly gadolinium-enhancing meningiomas (SBR=2.4, 1.7). The high-resolution, bright images were sufficient for the surgeon to appreciate the underlying anatomy in the near-infrared mode. However, system 1 was not able to visualize fluorescence from a weakly-enhancing intraparenchymal metastasis. In contrast, system 2 successfully visualized both the meningioma and the metastasis but lacked high resolution stereopsis.

Conclusion: Three-dimensional exoscope systems provide an alternative visualization platform for both standard microsurgery and near-infrared fluorescent guided surgery. However, when tumor fluorescence is weak (i.e., low fluorophore uptake, deep tumors), highly sensitive near-infrared visualization systems may be required.

키워드

Neuroimaging; 3D exoscope; Fluorescence; Indocyanine-green; Central nervous system neoplasms; Molecular imaging

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