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 2

Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view in Case . (a) Preoperative coronal Gd-enhanced MRI in Case showing a pituitary tumor with extensive invasion into the sphenoidal sinus. (b) Preoperative 3D-CT and MRI fusion model demonstrating that bilateral ICAs (C3 and C4 portions) are buried in the invasive tumor at the anterior plane of the sella (inset) (stars: C4; asterisks: C3). (c) Endoscopic view before tumor resection showing the massive tumor that widely protruded into the sphenoidal sinus. (d) A neuronavigation system demonstrating the locations of the ICAs and the destroyed sella in the endoscopic view (c). CT images on the navigation display show the position of the chip and trajectory of the flexible probe that was placed on the marked position (black arrow) on the endoscopic view (c). (e) Endoscopic view after resection of the tumor showing the widely eroded sellar floor occupied with residual intrasellar tumor and intact bony structures over the ICAs (arrowheads: eroded sellar floor; CP: ICA prominence). T: tumor; the area of white-dashed line: endoscopic view in (c).

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