Intraoperative Real-Time Near-Infrared Image-Guided Surgery to Identify Intracranial Meningiomas via Microscope

• DOI: 10.3389/fnins.2022.837349
• Publication Date: 2022-05-04T06:36:33Z
• Authors: Jun Muto; Yutaka Mine; Yuya Nishiyama; Kazuhiro Murayama; Seiji Yamada; Daijiro Kojima; Motoharu Hayakawa; Kazuhide Adachi; Mitsuhiro Hasegawa; John Y. K. Lee; Yuichi Hirose
• Keywords: Indocyanine Green; Brain tumor

Meningiomas are a common pathology in the central nervous system requiring complete surgical resection. However, cases of recurrence and post-irradiation, accurate identification tumor remnants dural tail under bright light remains challenging. We aimed to perform real-time intraoperative visualization meningioma using delayed-window indocyanine green (ICG) technique with microscopy. Fifteen patients intracranial received 0.5 mg/kg ICG few hours before observation during surgery. used near-infrared (NIR) fluorescence identify location. NIR could visualize meningiomas 12 out 15 cases. Near-infrared surgery ranged from 1 4 h after administration ICG. The mean signal-to-background ratio (SBR) (DWIG) was 3.3 ± 2.6. gadolinium-enhanced T1 signal brain (T1BR) (2.5 0.9) significantly correlated SBR (p = 0.016). K trans , indicating blood-brain barrier permeability, < 0.0001) T1BR 0.013) on dynamic contrast-enhanced magnetic resonance imaging (MRI). DWIG demonstrated sensitivity 94%, specificity 38%, positive predictive value (PPV) 76%, negative (NPV) 75% for meningiomas. This is first pilot study which fluorescence-guided intraoperatively comparable second-window terms SBR. Gadolinium-enhanced may predict meningioma. Blood-brain permeability as shown by MRI can contribute gadolinium enhancement retention NIR.