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 3

Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view along with ICG endoscopic views at each elapsed time in Case . (a) Preoperative sagittal Gd-enhanced MRI in Case showing a cystic lesion in the sellar and suprasellar region. (b) A fusion model of 3D-CT and MRI demonstrating an anatomical relationship between bilateral ICAs and the pituitary gland that is flattened at the sellar floor. The bony structures are partially eliminated (asterisks: C3; stars: C4) and the normal pituitary gland (PG). (c) Endoscopic view demonstrating the structures around the sella that correspond to the fusion model. (d, e, f) ICG endoscopic views visualizing bilateral ICAs in the carotid prominences (stars) at the earliest phase, followed by ICS (arrowheads), and the normal pituitary gland (PG) at 5 to 10 s later.

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