Dose optimization of second window indocyanine green in meningioma patients.
Clin Neurol Neurosurg
; 243: 108385, 2024 Aug.
Article
em En
| MEDLINE
| ID: mdl-38878642
ABSTRACT
OBJECTIVE:
Surgery remains the first line treatment for meningiomas and can benefit from fluorescence-guided surgical techniques such as second-window indocyanine green (SWIG). In the current study, we compared the use of the standard SWIG dose of 5.0â¯mg/kg relative to 2.5â¯mg/kg indocyanine green (ICG) in meningioma patients.METHODS:
Patients were prospectively enrolled in an IRB-approved study of SWIG and received either the standard dose of 5.0â¯mg/kg or a reduced dose of 2.5â¯mg/kg of ICG around 24â¯h prior to their surgery. Intraoperative near-infrared fluorescence imaging was performed with exo- and endoscopic systems. Signal-to-background ratio (SBR) was calculated to quantify fluorescence and was compared between 5.0â¯mg/kg and 2.5â¯mg/kg ICG. All patients received pre-operative MRI and, in select cases, the pre-operative MRI was correlated to intraoperative fluorescence imaging. RESULTS/DISCUSSION:
In the current study, we found no significant difference in the SBR of meningiomas in patients that were administered with either 5.0â¯mg/kg or 2.5â¯mg/kg ICG. However, in five patients that received the standard-dose SWIG regimen of 5.0â¯mg/kg ICG we observed dose-related fluorescence quenching - referred to as "inversion" - that interfered with tumor visualization during fluorescence-guided surgery (FGS). When correlated to pre-operative MRI, a similar rim pattern was observed around the primary tumor on T2 FLAIR, which, in retrospect, could be used as a predictor for inversion during FGS in meningioma patients receiving standard-dose ICG.CONCLUSION:
This study demonstrated that a reduced ICG dose was as effective as standard-dose SWIG in meningioma patients. We therefore recommend to adjust the standard ICG dose for meningioma patients to 2.5â¯mg/kg particularly when rim enhancement is observed on pre-operative T2 FLAIR.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Verde de Indocianina
/
Neoplasias Meníngeas
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Meningioma
Limite:
Adult
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Aged
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Female
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Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Clin Neurol Neurosurg
Ano de publicação:
2024
Tipo de documento:
Article