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 4

Preoperative image of a fusion model of 3D-CT and MRI and intraoperative endoscopic view and ICG fluorescence views in Case . (a, b) Preoperative coronal and sagittal Gd-enhanced MRI in Case showing a pituitary tumor extending into the sphenoidal sinus with involvement of both ICAs by the tumor. (c) Preoperative 3D-CT and MRI fusion model revealing the relationship between the tumor and the vital structures such as the ICAs and optic nerves and the location of the ICAs (asterisks: C3; stars: C4) by eliminating bony structures. (d) Endoscopic view after decompression of the tumor showing residual tumor bilaterally with descending diaphragma sellae (DS) centrally. (e, f) ICG endoscopic views visualizing the right ICA (asterisk: C3; star: C4) under the tumor and the normal pituitary gland (PG) at the posterior part of the diaphragma sellae. T: tumor.

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