Current Applications and Technical Considerations of Indocyanine Green During Endonasal Endoscopic Approaches for Resection of Pituitary Region Tumors: A Systematic Review.

Abstract

Endoscopic endonasal approaches (EEAs) are now common practice to treat sellar and parasellar tumors. Indocyanine green (ICG) is a fluorescent dye with multiple novel applications during endonasal approaches. This systematic review assesses the role of ICG in enhancing tumor resection, predicting postoperative visual outcomes, and reducing endocrinological complications. A systematic search of PubMed, Embase, Web of Science, and SCOPUS identified studies using ICG during EEA for sellar and parasellar tumors. Inclusion criteria targeted studies reporting on ICG's role in tumor resection, visual, and endocrinological outcomes in patients undergoing EEA. Out of 765 screened abstracts, 14 studies met inclusion criteria, including data from 244 patients. Despite variations in ICG dosage, administration timing, and visualization techniques, ICG consistently improved the identification of tumor boundaries, the internal carotid artery, and surrounding structures, facilitating real-time vascular mapping and enhancing gross total resection rates. However, no clear advantage in resection extent over other dyes or nondye methods was observed due to the lack of comparative studies. ICG angiography was also used for intraoperative monitoring of visual function by assessing optic chiasm perfusion. The evidence supporting ICG use in evaluating endocrinological outcomes is limited. ICG enhances the visualization of critical structures in the sellar region, which has aided in achieving safe maximal gross total resection. Emerging uses include real-time monitoring of optic chiasm perfusion and pituitary blood flow, possibly helping prevent postoperative visual and endocrinological deficits.