Our Summary

This study explores the effectiveness of a technique called Indocyanine Green (ICG) fluorescence imaging during endoscopic sinus and skull base surgeries. Currently, surgeons identify important arteries during these procedures using anatomical knowledge, CT scans, and a method called Doppler flowmetry. However, this new technique may provide another useful tool.

The researchers carried out tests on eight patients who had agreed to participate in the study. They carried out the usual procedures in the surgeries, then used an ICG endoscope to examine the arteries. They then compared these results to preoperative CT images to identify five key arteries.

The results showed that ICG was successful at identifying these arteries, with the highest success rate in identifying the anterior ethmoidal artery (AEA) (100% identification rate), the postnasal artery (PNA) (86%), and the internal carotid artery (ICA) (56%). However, it was less successful at identifying the posterior ethmoidal artery (PEA) and the sphenopalatine artery (SPA), with a 25% success rate.

This suggests that ICG could potentially be a useful tool in these surgeries, particularly for identifying the AEA, PNA, and ICA arteries. By helping to avoid vascular injuries, this could make endoscopic sinus and skull base surgeries safer and more effective. The effectiveness of the ICG technique was influenced by factors such as the thickness of the bone or soft tissue above the arteries, the presence of blood clots, and the settings of the near-infrared light used in the procedure.

FAQs

  1. What is the Indocyanine Green (ICG) fluorescence imaging technique?
  2. How successful was the ICG technique in identifying key arteries during endoscopic sinus and skull base surgeries in the study?
  3. What factors influence the effectiveness of the ICG technique in these surgeries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about sinus surgery is to ask about the use of Indocyanine Green (ICG) fluorescence imaging during the procedure. This technique can help surgeons identify important arteries more accurately, potentially reducing the risk of vascular injuries and making the surgery safer and more effective. It’s important to discuss this option with your surgeon and see if it could be beneficial for your specific case.

Suitable For

Patients who are typically recommended for sinus surgery include those with chronic sinusitis that has not responded to other treatments, nasal polyps, sinus tumors, deviated septum, or structural abnormalities in the sinuses or nasal passages. These patients may experience symptoms such as chronic sinus infections, difficulty breathing through the nose, facial pain or pressure, and reduced sense of smell. In cases where the sinus surgery involves the skull base, patients may also have conditions such as cerebrospinal fluid leaks or tumors affecting the skull base.

Timeline

Before sinus surgery, a patient may experience symptoms such as chronic sinusitis, nasal congestion, facial pain, and difficulty breathing. They may undergo diagnostic tests such as CT scans and nasal endoscopy to determine the extent of their condition.

After sinus surgery, the patient will typically experience some pain, swelling, and congestion in the nasal area. They may need to take pain medication and use nasal sprays to manage these symptoms. Over time, the patient should experience relief from their sinus symptoms and improved breathing. Follow-up appointments with the surgeon will be necessary to monitor healing and ensure that the surgery was successful in addressing the underlying issues.

What to Ask Your Doctor

Some questions a patient should ask their doctor about sinus surgery and the use of ICG fluorescence imaging include:

  1. How will ICG fluorescence imaging benefit me during my sinus surgery?
  2. What specific arteries will the ICG be used to identify during my procedure?
  3. What is the success rate of ICG in identifying these arteries, based on the study results?
  4. Are there any potential risks or limitations associated with using ICG during my surgery?
  5. How will the information obtained through ICG imaging help improve the safety and effectiveness of my surgery?
  6. What factors can affect the effectiveness of ICG in identifying arteries during the procedure?
  7. Are there any alternative techniques or technologies that can be used in conjunction with or instead of ICG fluorescence imaging?
  8. Will I need any additional preoperative testing or preparation if I am undergoing surgery with the use of ICG?
  9. What is the experience of the surgical team with using ICG fluorescence imaging in sinus and skull base surgeries?
  10. How will the results of the ICG imaging be used to guide the surgical plan and ensure the best possible outcome for me?

Reference

Authors: Inokuchi G, Mine M, Tamagawa K, Tatehara S, Yui M, Uozumi Y, Fujita Y, Nakai T, Nibu KI. Journal: Am J Otolaryngol. 2024 Jul-Aug;45(4):104343. doi: 10.1016/j.amjoto.2024.104343. Epub 2024 May 6. PMID: 38729013