Impact of indocyanine green fluorescent image-guided surgery for parapharyngeal space tumours

• Published in: Journal of cranio-maxillo-facial surgery Vol. 42; no. 6; pp. 835 - 838
• Main Authors: Yokoyama, Junkichi, Ooba, Shinichi, Fujimaki, Mitsuhisa, Anzai, Takashi, Yoshii, Ryota, Kojima, Masataka, Ikeda, Katsuhisa
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.09.2014
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - surgery; Dentistry; Endoscopic surgery; Fluorescent Dyes - administration & dosage; Head and neck cancer; Humans; Hypopharyngeal Neoplasms - surgery; Indocyanine green (ICG); Indocyanine Green - administration & dosage; Injections, Intravenous; Intraoperative Complications - prevention & control; Lymph Node Excision - methods; Lymphatic Metastasis - pathology; Middle Aged; Minimally invasive surgery; Navigation surgery; Neck Dissection - methods; Neoplasm Recurrence, Local - surgery; Neoplasm Staging; Optical Imaging - methods; Oropharyngeal Neoplasms - surgery; Parapharyngeal space tumours; Pharyngeal Neoplasms - surgery; Robotic surgery; Surgery; Surgery, Computer-Assisted - methods; Robotic surgery; Navigation surgery; Endoscopic surgery; Minimally invasive surgery; Indocyanine green (ICG); Head and neck cancer; Parapharyngeal space tumours
• ISSN: 1010-5182; 1878-4119
• DOI: 10.1016/j.jcms.2013.12.001

Abstract In parapharyngeal space dissection, significant complications such as dysphagia and carotid artery rupture have been reported. In order to resect tumours safely in narrow parapharyngeal space, we propose indocyanine green (ICG) florescence image for navigation surgery. Objective To evaluate the usefulness of ICG fluorescent image-guided surgery for parapharyngeal space tumours. Methods 0.5 mg/kg of ICG was injected via the cephalic vein. Observation of the fluorescent image was performed with HEMS (HyperEye Medical System) at 10–30 min after injection. At first, the position of the tumour was marked over pharyngeal mucosa according to ICG fluorescence imaging with HEMS. We also confirmed submucosal tumours hidden under fascia using HEMS imaging again and resected them. Results All tumours displayed bright fluorescence emissions which clearly contrasted with the normal structures. Even with the submucosal tumour covered with and obscured by fasciae, we could observe the tumour clearly under HEMS imaging. Tumours behind the carotid artery and lower cranial nerves also were displayed bright fluorescence emissions and were clearly detected. As a result, we could completely remove the tumour safely and noninvasively to preserve pharyngeal functions. Conclusion ICG fluorescence imaging is effective for the detection and resection of the parapharyngeal space tumours with preserving functions.