1. Dose optimization of second window indocyanine green in meningioma patients.
- Author
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Karsalia R, Zhou CC, Muhammad N, Teng CW, Singh Y, Huang V, Harmsen S, and Lee JYK
- Subjects
- Humans, Female, Male, Middle Aged, Aged, Coloring Agents administration & dosage, Adult, Optical Imaging methods, Prospective Studies, Neurosurgical Procedures methods, Magnetic Resonance Imaging methods, Indocyanine Green administration & dosage, Meningioma surgery, Meningioma diagnostic imaging, Meningeal Neoplasms surgery, Meningeal Neoplasms diagnostic imaging
- 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 5.0 mg/kg relative to 2.5 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 5.0 mg/kg or a reduced dose of 2.5 mg/kg of ICG around 24 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 5.0 mg/kg and 2.5 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 5.0 mg/kg or 2.5 mg/kg ICG. However, in five patients that received the standard-dose SWIG regimen of 5.0 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 T
2 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 2.5 mg/kg particularly when rim enhancement is observed on pre-operative T2 FLAIR., (Copyright © 2024. Published by Elsevier B.V.)- Published
- 2024
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