Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors

Acta Neurochir (Wien). 2019 Apr;161(4):695-706. doi: 10.1007/s00701-018-03778-0. Epub 2019 Feb 14.


Background: For the precise removal of pituitary tumors, preserving the surrounding normal structures, we need real-time intraoperative information on tumor location, margins, and surrounding structures. The aim of this study was to evaluate the benefits of a new intraoperative real-time imaging modality using indocyanine green (ICG) fluorescence through an endoscopic system during transsphenoidal surgery (TSS) for pituitary tumors.

Methods: Between August 2013 and October 2014, 20 patients with pituitary and parasellar region tumors underwent TSS using the ICG fluorescence endoscopic system. We used a peripheral vein bolus dose of 6.25 mg/injection of ICG, started with a time counter, and examined how each tissue type increased and decreased in fluorescence through time.

Results: A total of 33 investigations were performed for 20 patients: 9 had growth hormone secreting adenomas, 6 non-functioning pituitary adenomas, 3 Rathke's cleft cysts, 1 meningioma, and 1 pituicytoma. After the injection of ICG, the intensity of fluorescence of tumor and normal tissues under near-infrared light showed clear differences. We could differentiate tumor margins from adjacent normal tissues and define clearly the surrounding normal structures using the different fluorescent intensities time changes and tissue-specific fluorescence patterns.

Conclusions: The ICG endoscopic system is simple, user-friendly, quick, cost-effective, and reliable. The method offered real-time information during TSS to delimit pituitary and parasellar region tumor tissue from surrounding normal structures. This method can contribute to the improvement of total removal rates of tumors, reduction of complications after TSS, saving surgical time, and preserving endocrinological functions.

Keywords: Endoscope; Indocyanine green fluorescence; Pituitary tumor; Real-time information; Transsphenoidal surgery; Tumor visualization.

MeSH terms

  • Adenoma / surgery*
  • Endoscopy / adverse effects
  • Endoscopy / methods
  • Female
  • Fluorescence
  • Humans
  • Indocyanine Green
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods*
  • Pituitary Neoplasms / surgery*
  • Postoperative Complications / epidemiology*
  • Surgery, Computer-Assisted / adverse effects
  • Surgery, Computer-Assisted / methods*


  • Indocyanine Green