Usefulness of an Image Fusion Model Using Three-Dimensional CT and MRI with Indocyanine Green Fluorescence Endoscopy as a Multimodal Assistant System in Endoscopic Transsphenoidal Surgery

Figure 1

An illustrative case showing images of a fusion model of 3D-CT and MRI and intraoperative ICG endoscopy along with the corresponding endoscopic views. (a) Gadolinium- (Gd-) enhanced magnetic resonance imaging (MRI) showing a pituitary adenoma with suprasellar extension (coronal section). (b) Preoperative simulated view of the endoscopic endonasal transsphenoidal approach produced by the fusion model of 3D-CT and MRI that show bony prominences of the internal carotid arteries (ICAs), optic canals, and pituitary tumor around the sellar floor. (c) Intraoperative endoscopic view showing bony structures around the sellar floor (unopened). (d) Intraoperative endoscopic view showing the intrasellar structures, mainly the descending diaphragma sellae (DS) with the normal pituitary gland after total resection of the tumor. (e) Indocyanine green (ICG) endoscope showing vital structures such as the ICAs (a view corresponding to (c)) and (f) ICG endoscope showing ICAs in the right cavernous sinus and a normal pituitary gland adhered to the DS (SF: sellar floor; TS: tuberculum sella; CI: clival indentation; CP: ICA prominence; stars: C4 portion of ICA; asterisks: C3 portion in the cavernous sinus; OC: optic canal; and T: tumor). (e) Before opening the sella; (f) after tumor resection.

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